[18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches

Evelyn E. C. de Jong; Wouter van Elmpt; Ralph T. H. Leijenaar; Otto S. Hoekstra; Harry J. M. Groen; Egbert F. Smit; Ronald Boellaard; Vincent van der Noort; Esther G. C. Troost; Philippe Lambin; Anne-Marie C. Dingemans

doi:10.1007/s00259-016-3498-y

[18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches

Evelyn E. C. de Jong^*, Wouter van Elmpt, Ralph T. H. Leijenaar, Otto S. Hoekstra, Harry J. M. Groen, Egbert F. Smit, Ronald Boellaard, Vincent van der Noort, Esther G. C. Troost, Philippe Lambin, Anne-Marie C. Dingemans

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Purpose Nitroglycerin (NTG) is a vasodilating drug, which increases tumor blood flow and consequently decreases hypoxia. Therefore, changes in [18F] fluorodeoxyglucose positron emission tomography ([18F] FDG PET) uptake pattern may occur. In this analysis, we investigated the feasibility of [18F] FDG PET for response assessment to paclitaxel-carboplatin-bevacizumab (PCB) treatment with and without NTG patches. And we compared the [18F] FDG PET response assessment to RECIST response assessment and survival.

Methods A total of 223 stage IV non-small cell lung cancer (NSCLC) patients were included in a phase II study (NCT01171170) randomizing between PCB treatment with or without NTG patches. For 60 participating patients, a baseline and a second [18F] FDG PET/computed tomography (CT) scan, performed between day 22 and 24 after the start of treatment, were available. Tumor response was defined as a 30 % decrease in CT and PET parameters, and was compared to RECIST response at week 6. The predictive value of these assessments for progression free survival (PFS) and overall survival (OS) was assessed with and without NTG.

Results A 30 % decrease in SUVpeak assessment identified more patients as responders compared to a 30 % decrease in CT diameter assessment (73 % vs. 18 %), however, this was not correlated to OS (SUVpeak30 p = 0.833; CTdiameter30 p = 0.557). Changes in PET parameters between the baseline and the second scan were not significantly different for the NTG group compared to the control group (p value range 0.159-0.634). The CT-based (part of the [18F] FDG PET/CT) parameters showed a significant difference between the baseline and the second scan for the NTG group compared to the control group (CT diameter decrease of 7 +/- 23 % vs. 19 +/- 14 %, p = 0.016, respectively).

Conclusions The decrease in tumoral FDG uptake in advanced NSCLC patients treated with chemotherapy with and without NTG did not differ between both treatment arms. Early PET-based response assessment showed more tumor responders than CT-based response assessment (part of the [18F] FDG PET/CT); this was not correlated to survival. This might be due to timing of the [18F] FDG PET shortly after the bevacizumab infusion.

Original language	English
Pages (from-to)	8-16
Number of pages	9
Journal	European Journal of Nuclear Medicine and Molecular Imaging
Volume	44
Issue number	1
DOIs	https://doi.org/10.1007/s00259-016-3498-y
Publication status	Published - Jan 2017

Keywords

[18F]FDG PET/CT
Response assessment
Nitroglycerin
Bevacizumab
Stage IV NSCLC
POSITRON-EMISSION-TOMOGRAPHY
RANDOMIZED PHASE-II
TUMOR RESPONSE
F-18-FDG PET
HYPOXIA
CHEMOTHERAPY
QUANTIFICATION
CHEMOSENSITIVITY
ERLOTINIB
SURVIVAL

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Cite this

de Jong, E. E. C., van Elmpt, W., Leijenaar, R. T. H., Hoekstra, O. S., Groen, H. J. M., Smit, E. F., Boellaard, R., van der Noort, V., Troost, E. G. C., Lambin, P., & Dingemans, A.-M. C. (2017). [18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches. European Journal of Nuclear Medicine and Molecular Imaging, 44(1), 8-16. https://doi.org/10.1007/s00259-016-3498-y

@article{633de902215e400fad9d3ea884858416,

title = "[18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches",

abstract = "Purpose Nitroglycerin (NTG) is a vasodilating drug, which increases tumor blood flow and consequently decreases hypoxia. Therefore, changes in [18F] fluorodeoxyglucose positron emission tomography ([18F] FDG PET) uptake pattern may occur. In this analysis, we investigated the feasibility of [18F] FDG PET for response assessment to paclitaxel-carboplatin-bevacizumab (PCB) treatment with and without NTG patches. And we compared the [18F] FDG PET response assessment to RECIST response assessment and survival.Methods A total of 223 stage IV non-small cell lung cancer (NSCLC) patients were included in a phase II study (NCT01171170) randomizing between PCB treatment with or without NTG patches. For 60 participating patients, a baseline and a second [18F] FDG PET/computed tomography (CT) scan, performed between day 22 and 24 after the start of treatment, were available. Tumor response was defined as a 30 % decrease in CT and PET parameters, and was compared to RECIST response at week 6. The predictive value of these assessments for progression free survival (PFS) and overall survival (OS) was assessed with and without NTG.Results A 30 % decrease in SUVpeak assessment identified more patients as responders compared to a 30 % decrease in CT diameter assessment (73 % vs. 18 %), however, this was not correlated to OS (SUVpeak30 p = 0.833; CTdiameter30 p = 0.557). Changes in PET parameters between the baseline and the second scan were not significantly different for the NTG group compared to the control group (p value range 0.159-0.634). The CT-based (part of the [18F] FDG PET/CT) parameters showed a significant difference between the baseline and the second scan for the NTG group compared to the control group (CT diameter decrease of 7 +/- 23 % vs. 19 +/- 14 %, p = 0.016, respectively).Conclusions The decrease in tumoral FDG uptake in advanced NSCLC patients treated with chemotherapy with and without NTG did not differ between both treatment arms. Early PET-based response assessment showed more tumor responders than CT-based response assessment (part of the [18F] FDG PET/CT); this was not correlated to survival. This might be due to timing of the [18F] FDG PET shortly after the bevacizumab infusion.",

keywords = "[18F]FDG PET/CT, Response assessment, Nitroglycerin, Bevacizumab, Stage IV NSCLC, POSITRON-EMISSION-TOMOGRAPHY, RANDOMIZED PHASE-II, TUMOR RESPONSE, F-18-FDG PET, HYPOXIA, CHEMOTHERAPY, QUANTIFICATION, CHEMOSENSITIVITY, ERLOTINIB, SURVIVAL",

author = "{de Jong}, {Evelyn E. C.} and {van Elmpt}, Wouter and Leijenaar, {Ralph T. H.} and Hoekstra, {Otto S.} and Groen, {Harry J. M.} and Smit, {Egbert F.} and Ronald Boellaard and {van der Noort}, Vincent and Troost, {Esther G. C.} and Philippe Lambin and Dingemans, {Anne-Marie C.}",

year = "2017",

month = jan,

doi = "10.1007/s00259-016-3498-y",

language = "English",

volume = "44",

pages = "8--16",

journal = "European Journal of Nuclear Medicine and Molecular Imaging",

issn = "1619-7070",

publisher = "Springer, Cham",

number = "1",

}

de Jong, EEC, van Elmpt, W , Leijenaar, RTH, Hoekstra, OS, Groen, HJM, Smit, EF, Boellaard, R, van der Noort, V, Troost, EGC, Lambin, P & Dingemans, A-MC 2017, '[18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches', European Journal of Nuclear Medicine and Molecular Imaging, vol. 44, no. 1, pp. 8-16. https://doi.org/10.1007/s00259-016-3498-y

[18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches. / de Jong, Evelyn E. C.; van Elmpt, Wouter ; Leijenaar, Ralph T. H. et al.
In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 44, No. 1, 01.2017, p. 8-16.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - [18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches

AU - de Jong, Evelyn E. C.

AU - van Elmpt, Wouter

AU - Leijenaar, Ralph T. H.

AU - Hoekstra, Otto S.

AU - Groen, Harry J. M.

AU - Smit, Egbert F.

AU - Boellaard, Ronald

AU - van der Noort, Vincent

AU - Troost, Esther G. C.

AU - Lambin, Philippe

AU - Dingemans, Anne-Marie C.

PY - 2017/1

Y1 - 2017/1

N2 - Purpose Nitroglycerin (NTG) is a vasodilating drug, which increases tumor blood flow and consequently decreases hypoxia. Therefore, changes in [18F] fluorodeoxyglucose positron emission tomography ([18F] FDG PET) uptake pattern may occur. In this analysis, we investigated the feasibility of [18F] FDG PET for response assessment to paclitaxel-carboplatin-bevacizumab (PCB) treatment with and without NTG patches. And we compared the [18F] FDG PET response assessment to RECIST response assessment and survival.Methods A total of 223 stage IV non-small cell lung cancer (NSCLC) patients were included in a phase II study (NCT01171170) randomizing between PCB treatment with or without NTG patches. For 60 participating patients, a baseline and a second [18F] FDG PET/computed tomography (CT) scan, performed between day 22 and 24 after the start of treatment, were available. Tumor response was defined as a 30 % decrease in CT and PET parameters, and was compared to RECIST response at week 6. The predictive value of these assessments for progression free survival (PFS) and overall survival (OS) was assessed with and without NTG.Results A 30 % decrease in SUVpeak assessment identified more patients as responders compared to a 30 % decrease in CT diameter assessment (73 % vs. 18 %), however, this was not correlated to OS (SUVpeak30 p = 0.833; CTdiameter30 p = 0.557). Changes in PET parameters between the baseline and the second scan were not significantly different for the NTG group compared to the control group (p value range 0.159-0.634). The CT-based (part of the [18F] FDG PET/CT) parameters showed a significant difference between the baseline and the second scan for the NTG group compared to the control group (CT diameter decrease of 7 +/- 23 % vs. 19 +/- 14 %, p = 0.016, respectively).Conclusions The decrease in tumoral FDG uptake in advanced NSCLC patients treated with chemotherapy with and without NTG did not differ between both treatment arms. Early PET-based response assessment showed more tumor responders than CT-based response assessment (part of the [18F] FDG PET/CT); this was not correlated to survival. This might be due to timing of the [18F] FDG PET shortly after the bevacizumab infusion.

AB - Purpose Nitroglycerin (NTG) is a vasodilating drug, which increases tumor blood flow and consequently decreases hypoxia. Therefore, changes in [18F] fluorodeoxyglucose positron emission tomography ([18F] FDG PET) uptake pattern may occur. In this analysis, we investigated the feasibility of [18F] FDG PET for response assessment to paclitaxel-carboplatin-bevacizumab (PCB) treatment with and without NTG patches. And we compared the [18F] FDG PET response assessment to RECIST response assessment and survival.Methods A total of 223 stage IV non-small cell lung cancer (NSCLC) patients were included in a phase II study (NCT01171170) randomizing between PCB treatment with or without NTG patches. For 60 participating patients, a baseline and a second [18F] FDG PET/computed tomography (CT) scan, performed between day 22 and 24 after the start of treatment, were available. Tumor response was defined as a 30 % decrease in CT and PET parameters, and was compared to RECIST response at week 6. The predictive value of these assessments for progression free survival (PFS) and overall survival (OS) was assessed with and without NTG.Results A 30 % decrease in SUVpeak assessment identified more patients as responders compared to a 30 % decrease in CT diameter assessment (73 % vs. 18 %), however, this was not correlated to OS (SUVpeak30 p = 0.833; CTdiameter30 p = 0.557). Changes in PET parameters between the baseline and the second scan were not significantly different for the NTG group compared to the control group (p value range 0.159-0.634). The CT-based (part of the [18F] FDG PET/CT) parameters showed a significant difference between the baseline and the second scan for the NTG group compared to the control group (CT diameter decrease of 7 +/- 23 % vs. 19 +/- 14 %, p = 0.016, respectively).Conclusions The decrease in tumoral FDG uptake in advanced NSCLC patients treated with chemotherapy with and without NTG did not differ between both treatment arms. Early PET-based response assessment showed more tumor responders than CT-based response assessment (part of the [18F] FDG PET/CT); this was not correlated to survival. This might be due to timing of the [18F] FDG PET shortly after the bevacizumab infusion.

KW - [18F]FDG PET/CT

KW - Response assessment

KW - Nitroglycerin

KW - Bevacizumab

KW - Stage IV NSCLC

KW - POSITRON-EMISSION-TOMOGRAPHY

KW - RANDOMIZED PHASE-II

KW - TUMOR RESPONSE

KW - F-18-FDG PET

KW - HYPOXIA

KW - CHEMOTHERAPY

KW - QUANTIFICATION

KW - CHEMOSENSITIVITY

KW - ERLOTINIB

KW - SURVIVAL

U2 - 10.1007/s00259-016-3498-y

DO - 10.1007/s00259-016-3498-y

M3 - Article

C2 - 27600280

SN - 1619-7070

VL - 44

SP - 8

EP - 16

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

IS - 1

ER -