title: Volumetric FDG-PET predicts overall and progression- free survival after 14 days of targeted therapy in metastatic renal cell carcinoma.
abstract: BACKGROUND
  To determine whether changes in the metabolism of metastatic renal cell carcinoma (mRCC) assessed by F18-FDG-PET after 14 and 28 days of treatment with tyrosine kinase inhibitors can predict overall and progression- free patient survival.
  
  
  METHODS
  Thirty-nine consecutive patients with mRCC were included prospectively and underwent PET examinations prior to and after 14 and 28 days of standard treatment with sunitinib (n=18), sorafenib (n=19) or pazopanib (n=2). The PET response was analyzed in terms of SUVmax, SULpeak, and total lesion glycolysis and a positive response (defined as a 30% reduction) compared to overall and progression- free survival.
  
  
  RESULTS
  Thirty-five patients with at least one metabolically active metastatic lesion prior to treatment underwent additional FDG-PET examinations after 14 (n=32) and/or 28 days (n=30) of treatment. Changes in either SULpeak or total lesion glycolysis were correlated to both progression-free and overall survival (for TLG2.5 responders, HR=0.38 (95% CI: 0.18-0.83) and 0.22 (95% CI: 0.09-0.53), and for TLG50 responders, HR=0.25 (0.10-0.62) and 0.25 (95% CI: 0.11-0.57) and for SULpeak responders, HR=0.39 (95% CI: 0.17-0.91) and 0.38 (95% CI: 0.15-0.93), respectively). In contrast SUVmax response did not predict progression- free or overall survival (HR=0.43 (95% CI: 0.18-1.01) and 0.50 (95% CI: 0.21-1.19), respectively).
  
  
  CONCLUSIONS
  Assessment of early changes in SULpeak and total lesion glycolysis undergoing treatment with tyrosine kinase inhibitors by FDG-PET can possibly predict progression- free and overall survival in patients with mRCC.
authors.affiliation: Department of Diagnostic Radiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. jacob.farnebo@ki.se.
authors.forename: Jacob
authors.initials: J
authors.lastname: Farnebo
authors.forename: Per
authors.initials: P
authors.lastname: Grybäck
authors.forename: Ulrika
authors.initials: U
authors.lastname: Harmenberg
authors.forename: Anna
authors.initials: A
authors.lastname: Laurell
authors.forename: Peter
authors.initials: P
authors.lastname: Wersäll
authors.forename: Lennart K
authors.initials: LK
authors.lastname: Blomqvist
authors.forename: Anders
authors.initials: A
authors.lastname: Ullén
authors.forename: Per
authors.initials: P
authors.lastname: Sandström
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D054893:Cone-Beam Computed Tomography; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007191:Indazoles; D007211:Indoles / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009362:Neoplasm Metastasis; D049268:Positron-Emission Tomography; D011379:Prognosis; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors / Q000235:genetics* / Q000378:metabolism; D011743:Pyrimidines / Q000008:administration & dosage; D011758:Pyrroles / Q000008:administration & dosage; D013449:Sulfonamides / Q000008:administration & dosage; D000077210:Sunitinib; D016896:Treatment Outcome
chemical_list: D007191:Indazoles; D007211:Indoles; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D019788:Fluorodeoxyglucose F18; C516667:pazopanib; D011505:Protein-Tyrosine Kinases; D000077210:Sunitinib