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E.E.C. De Jong
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-044 - FDG-PET/CT Based Response Prediction of Stage IV NSCLC Treated with Paclitaxel-Carboplatin-Bevacizumab with or without Nitroglycerin (ID 1229)
09:30 - 09:30 | Author(s): E.E.C. De Jong
- Abstract
Background:
A prospective study in stage IV non-small cell lung cancer (NSCLC) patients was performed to assess the predictive value of early response of the primary tumor evaluated by [18F]FDG-PET/CT to bevacizumab containing combination therapy with or without nitroglycerin (NTG) patches as first line treatment. NTG is a vasodilator which is hypothesized to increase tumor blood flow thereby decrease hypoxia, and 1) leading to a decrease in [18F]FDG uptake, and 2) facilitating early response assessment using [18F]FDG to predict treatment outcome.
Methods:
In total, 223 patients were randomized between carboplatin-paclitaxel-bevacizumab (PCB) with or without NTG (day -2 to +3; NVALT12 trial, NCT01171170). 78 patients were available for image analysis having undergone an [18F]FDG-PET/CT scan prior to the first cycle of chemotherapy and a second (optional) [18F]FDG-PET/CT scan at day 1-2 after start of the second cycle. The primary gross tumor volume (GTV) was delineated on both PET/CT scans. On the [18F]FDG-PET scan, the maximum standardized uptake value (SUV), mean SUV, peak SUV and total lesion glycolysis (TLG defined as SUVmean*CTvolume) were calculated and correlated with progression-free survival (PFS) and overall survival (OS). Early response assessment was quantified using relative changes in [18F]FDG-PET uptake parameters of the GTV expressed as delta. The median of the parameter of interest was used as cut-off value for both study arms for analysis using cox regression. Furthermore response was assessed according to PERCIST and RECIST.
Results:Hazard ratio os SUV parameters > versus < the median for PFS and OS
1) On average no decrease in [18F]FDG-PET uptake was observed for the experimental NTG group. However, patients in the experimental group showed a significantly larger variation in most SUV parameters of the second PET/CT scan compared to control group without NTG. 2) In table 1 the hazard ratios are shown for the relative delta SUVmax, SUVmean, SUVpeak and TLG for both study arms. In the experimental group, patients with a small delta TLG (<64%) had a shorter PFS than patients with a larger change in TLG (HR:1.064; 95% CI 1.002-1.131; p=0.043). Response assessed by PERCIST and RECIST did not predict for a longer PFS or OS.SUV parameter median PFS OS HR (p-value) 95% CI HR (p-value) 95% CI Delta PCB+NTG (%) SUVmax 40.4 1.026 (0.408) 0.966-1.090 1.006 (0.844) 0.945-1.071 SUVmean 39.9 1.048 (0.127) 0.987-1.113 1.034 (0.279) 0.973-1.099 SUVpeak 42.3 1.035 (0.258) 0.975-1.100 1.016 (0.615) 0.955-1.082 TLG 64.5 1.064 (0.043) 1.002-1.131 1.039 (0.221) 0.977-1.106 Delta PCB (%) SUVmax 53.2 1.027 (0.454) 0.957-1.103 1.009 (0.810) 0.939-1.084 SUVmean 51.6 1.027 (0.465) 0.957-1.102 1.011 (0.766) 0.941-1.086 SUVpeak 53.9 1.040 (0.281) 0.969-1.116 1.018 (0.623) 0.947-1.094 TLG 75.9 0.994 (0.873) 0.927-1.066 0.998 (0.951) 0.928-1.072
Conclusion:
Adding NTG did not result in a decrease in [18F]FDG-PET uptake compared to patients without NTG although NTG increased variability of the measured SUV parameters. Patients in the experimental NTG arm without an early response on [18F]FDG-PET/CT imaging had a worse PFS than patients with a response. For the group without NTG no difference was observed. Also, RECIST and PERCIST were not predictive.
