Role of FLT PET in malignant pleural mesothelioma - prediction of response to chemotherapy

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Mesothelioma is a cancer of the lining of the lung. Chemotherapy is often used to treat patients in order to reduce their symptoms and to improve quality and length of life. Not all patients however benefit from chemotherapy, and most patients will experience some side-effects. Currently CT scans are used to assess response to chemotherapy, however the way that mesothelioma grows makes measuring response difficult. CT scans also are not very sensitive in detecting response early - often 3 or 4 cycles of treatment (3-4 months) are required before benefit is seen. A test that could predict which patients were benefiting after only 1 cycle (3-4 weeks) of chemotherapy would be a great advantage, and may spare some patients unnecessary and potentially toxic treatment. Fluorothymidine (FLT) is a radioactive tracer that, after injection into a vein, is taken up by dividing cells. Tumour cells usually divide more actively than surrounding normal cells, and therefore when a positron emission tomography (PET) scan is performed it will demonstrate the tumour as a 'hot spot'. The amount of FLT uptake into the tumour depends on how much DNA synthesis (active cell division) is occurring. After chemotherapy, if the tumour responds it would be expected that the amount of FLT in the tumour will reduce. This can be assessed by repeating the FLT PET scan after the first cycle of chemotherapy. This study aims to assess the ability of the change in FLT uptake in mesothelioma after 1 cycle of chemotherapy to predict response, as measured on CT scans, and patient outcomes such as quality of life and survival. It is hoped that if successful this type of scan may improve patient care by selecting those who are likely to benefit from chemotherapy early and avoid unnecessary toxicity to patients who will not benefit from the treatment.