18F-Fluorodeoxyglucose PET/CT for Early Prediction of Outcomes in Patients with Advanced Lung Adenocarcinomas and EGFR Mutations Treated with First-Line EGFR-TKIs

Yu-Erh Huang; Ying-Huang Tsai; Yu-Jie Huang; Jr-Hau Lung; Kuo-Wei Ho; Tzu-Chen Yen; Sheng-Chieh Chan; Shu-Tian Chen; Ming-Feng Tsai; Ming-Szu Hung

doi:10.3390/cancers14061507

¹⁸F-Fluorodeoxyglucose PET/CT for Early Prediction of Outcomes in Patients with Advanced Lung Adenocarcinomas and EGFR Mutations Treated with First-Line EGFR-TKIs

Cancers (Basel). 2022 Mar 15;14(6):1507. doi: 10.3390/cancers14061507.

Authors

Yu-Erh Huang^{1

2}, Ying-Huang Tsai³, Yu-Jie Huang⁴, Jr-Hau Lung⁵, Kuo-Wei Ho⁶, Tzu-Chen Yen⁷, Sheng-Chieh Chan^{8

9}, Shu-Tian Chen^{2

10}, Ming-Feng Tsai⁶, Ming-Szu Hung^{2

3

11}

Affiliations

¹ Department of Nuclear Medicine, Jen-Ai Hospital, Dali Branch, No. 483, Dong Rong Rd., Dali District, Taichung City 412224, Taiwan.
² Department of Respiratory Care, Chang Gung University of Science and Technology, No. 2, Sec. West, Jiapu Rd., Puzi City 613, Chiayi County, Taiwan.
³ Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, No. 6, Sec. West, Jiapu Rd., Puzi City 613, Chiayi County, Taiwan.
⁴ Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapei Rd., Niaosong Dist., Kaohsiung City 833, Taiwan.
⁵ Department of Medical Research, Chang Gung Memorial Hospital, Chiayi Branch, No. 6, Sec. West, Jiapu Rd., Puzi City 613, Chiayi County, Taiwan.
⁶ Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chiayi Branch, No. 6, Sec. West, Jiapu Rd., Puzi City 613, Chiayi County, Taiwan.
⁷ Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan.
⁸ Department of Nuclear Medicine, Hualien Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, No. 707, Sec. 3, Chung-Yang Rd., Hualien City 970, Taiwan.
⁹ Department of Medicine, School of Medicine, Tzu Chi University, No. 701, Sec. 3, Chung-Yang Rd., Hualien City 970, Taiwan.
¹⁰ Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi Branch, No. 6, Sec. West, Jiapu Rd., Puzi City 613, Chiayi County, Taiwan.
¹¹ Department of Medicine, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan.

Abstract

This study aims to investigate the role of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in early prediction of response and survival following epithelial growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy in patients with advanced lung adenocarcinomas and EGFR mutations. Thirty patients with stage IIIB/IV lung adenocarcinomas and EGFR mutations receiving first-line EGFR-TKIs were prospectively evaluated between November 2012 and May 2015. EGFR mutations were quantified by delta cycle threshold (dCt). ¹⁸F-FDG PET/CT was performed before and 2 weeks after treatment initiation. PET response was assessed based on PET Response Criteria in Solid Tumors (PERCIST). Baseline and percentage changes in the summed standardized uptake value, metabolic tumor volume (bsumMTV and ΔsumMTV, respectively), and total lesion glycolysis of ≤5 target lesions/patient were calculated. The association between parameters (clinical and PET) and non-progression disease after 3 months of treatment in CT based on the Response Evaluation Criteria in Solid Tumors Version 1.1 (nPD_3mo), progression-free survival (PFS), and overall survival (OS) were tested. The median follow-up time was 19.6 months. The median PFS and OS were 12.0 and 25.3 months, respectively. The PERCIST criteria was an independent predictor of nPD_3mo (p = 0.009), dCt (p = 0.014) and bsumMTV (p = 0.014) were independent predictors of PFS, and dCt (p = 0.014) and ΔsumMTV (p = 0.005) were independent predictors of OS. ¹⁸F-FDG PET/CT achieved early prediction of outcomes in patients with advanced lung adenocarcinomas and EGFR mutations receiving EGFR-TKIs.

Keywords: 18F-FDG PET; adenocarcinoma of lung; early response evaluation; survival; tyrosine kinase inhibitors.

Grants and funding

CMRPG6B0191/Department of Medical Research of Chang Gung Memorial Hospital grant number