(18)F-FDG PET/CT for monitoring treatment responses to the epidermal growth factor receptor inhibitor erlotinib.
(18)F-FDG PET/CT for monitoring treatment responses to the epidermal growth factor receptor inhibitor erlotinib.
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DOI：
10.2967/jnumed.111.095257
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发表时间：
2011-11
期刊：
影响因子：
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通讯作者：
Allen-Auerbach MS
中科院分区：
文献类型：
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作者：
Benz MR;Herrmann K;Walter F;Garon EB;Reckamp KL;Figlin R;Phelps ME;Weber WA;Czernin J;Allen-Auerbach MS
非选择性非小细胞肺癌（NSCLC）患者对表皮生长因子受体抑制剂厄洛替尼（erlotinib）的应答率很低，在10%至20%之间。需要进行早期反应评估，以避免低效治疗的成本和副作用。在这里，我们确定肿瘤摄取18F-FDG的早期变化是否可以预测接受厄洛替尼治疗的非小细胞肺癌患者的无进展和总生存期。前瞻性纳入22例接受厄洛替尼治疗的III期或IV期NSCLC患者（6名男性，16名女性，平均年龄±SD， 64±13岁）。治疗开始前（n = 22）、治疗2周后（n = 22）、治疗78±21 d后（n = 11）分别进行18F-FDG PET/CT检查。每位患者最多测量5个病灶的肿瘤最大标准化摄取值。肿瘤反应使用修改后的实体瘤PET反应标准（使用最大标准化摄取值）进行分类。Kaplan-Meier分析的中位总生存期采用log-rank检验进行组间比较。总体中位进展时间为52 d（95%可信区间，47-57 d）。总中位生存时间为131 d（95%可信区间为0-351 d）。在早期随访PET中，进行性代谢性疾病患者的进展时间（47 vs 119 d, P < 0.001）和总生存期（87 vs 828 d, P = 0.01）明显短于稳定代谢性疾病或部分或完全代谢反应的患者。这些数据表明，在厄洛替尼治疗开始后早期进行18F-FDG PET/CT检查可以帮助识别从这种靶向治疗中受益的患者。
Response rates of unselected non–small cell lung cancer (NSCLC) patients to the epidermal growth factor receptor inhibitor erlotinib are low and range from 10% to 20%. Early response assessments are needed to avoid costs and side effects of inefficient treatments. Here we determined whether early changes in tumor uptake of 18F-FDG can predict progression-free and overall survival in NSCLC patients who are treated with erlotinib. Twenty-two patients (6 men, 16 women; mean age ± SD, 64 ± 13 y) with stage III or stage IV NSCLC who received erlotinib treatment were enrolled prospectively. 18F-FDG PET/CT was performed before the initiation of treatment (n = 22), after 2 wk (n = 22), and after 78 ± 21 d (n = 11). Tumor maximum standardized uptake values were measured for a maximum of 5 lesions for each patient. Tumor responses were classified using modified PET Response Criteria in Solid Tumors (use of maximum standardized uptake values). Median overall survival by Kaplan–Meier analysis was compared between groups using a log-rank test. The overall median time to progression was 52 d (95% confidence interval, 47–57 d). The overall median survival time was 131 d (95% confidence interval, 0–351 d). Patients with progressive metabolic disease on early follow-up PET showed a significantly shorter time to progression (47 vs. 119 d; P < 0.001) and overall survival (87 vs. 828 d; P = 0.01) than patients classified as having stable metabolic disease or partial or complete metabolic response. These data suggest that 18F-FDG PET/CT performed early after the start of erlotinib treatment can help to identify patients who benefit from this targeted therapy.