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[¹⁸F]Fluorothymidine Positron Emission Tomography before and 7 Days after Gefitinib Treatment Predicts Response in Patients with Advanced Adenocarcinoma of the Lung

Authors' Affiliations: ¹ Division of Oncology and ² Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

Requests for reprints: Sang-We Kim, Division of Oncology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap 2-dong, Songpa-gu, Seoul 138-736, South Korea. Phone: 82-2-3010-3215; Fax: 82-2-3010-6961; E-mail: swkim{at}amc.seoul.kr.

Purpose: To evaluate the usefulness of 3'-deoxy-3'-[¹⁸F]fluorothymidine (FLT)-positron emission tomography (PET) for predicting response and patient outcome of gefitinib therapy in patients with adenocarcinoma of the lung.

Experimental Design: Nonsmokers with advanced or recurrent adenocarcinoma of the lung were eligible. FLT-PET images of the thorax were obtained before and 7 days after the start of gefitinib (250 mg/d) therapy, the maximum standardized uptake values (SUVmax) of primary tumors were measured, and the percent changes in SUVmax were calculated. After 6 weeks of therapy, the responses were assessed by computed tomography of the chest.

Results: Among 31 patients who were enrolled, we analyzed 28 patients for whom we had complete data. Chest computed tomography revealed partial response in 14 (50%), stable disease in 4 (14%), and progressive disease in 10 (36%) after 6 weeks of treatment. Pretreatment SUVmax of the tumors did not differ between responders and nonresponders. At 7 days after the initiation of therapy, the percent changes in SUVmax were significantly different (–36.0 ± 15.4% versus 10.1 ± 19.5%; P < 0.001). Decrease of >10.9% in SUVmax was used as the criterion for predicting response. The positive and negative predictive values were both 92.9%. The time to progression was significantly longer in FLT-PET responders than nonresponders (median, 7.9 versus 1.2 months; P = 0.0041).

Conclusion: FLT-PET can predict response to gefitinib 7 days after treatment in nonsmokers with advanced adenocarcinoma of the lung. The change in tumor SUVmax obtained by FLT-PET seems to be a promising predictive variable.

Commentary

Proliferation Imaging to Measure Early Cancer Response to Targeted Therapy

David A. Mankoff and Janet F. Eary
Clin. Cancer Res. 2008 14: 7159-7160. [Abstract] [Full Text] [PDF]

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				D. A. Mankoff and J. F. Eary Proliferation Imaging to Measure Early Cancer Response to Targeted Therapy Clin. Cancer Res., November 15, 2008; 14(22): 7159 - 7160. [Abstract] [Full Text] [PDF]