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18F-Fluorodeoxyglucose Positron Emission Tomography versus Computed Tomography in Predicting Histopathological Response to Epidermal Growth Factor Receptor–Tyrosine Kinase Inhibitor Treatment in Resectable Non-Small Cell Lung Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To prospectively evaluate diagnostic computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for identification of histopathologic response to neoadjuvant erlotinib, an epidermal growth factor receptor–tyrosine kinase inhibitor in patients with resectable non-small cell lung cancer (NSCLC).

Methods

This study was designed as an open-label phase 2 trial, performed in four hospitals in the Netherlands. Patients received preoperative erlotinib 150 mg once daily for 3 weeks. CT and FDG-PET/CT were performed at baseline and after 3 weeks of treatment. CT was assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. FDG-PET/CT, tumor FDG uptake, and changes were measured by standardized uptake values (SUV). Radiologic and metabolic responses were compared to the histopathological response.

Results

Sixty patients were enrolled onto this study. In 53 patients (22 men, 31 women), the combination of CT, FDG-PET/CT, and histopathological evaluation was available for analysis. Three patients (6 %) had radiologic response. According to European Organisation for Research and Treatment of Cancer (EORTC) criteria, 15 patients (28 %) showed metabolic response. In 11 patients, histopathologic response (≥50 % necrosis) was seen. In predicting histopathologic response, relative FDG change in SUVmax showed more SUVmax decrease in the histopathologic response group (−32 %) versus the group with no pathologic response (−4 %) (p = 0.0132). Relative change in tumor size on diagnostic CT was similar in these groups with means close to 0.

Conclusions

FDG-PET/CT has an advantage over CT as a predictive tool to identify histopathologic response after 3 weeks of EGFR–TKI treatment in NSCLC patients.

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Acknowledgment

This phase 2 study is an investigator-initiated study, supported by an unrestricted educational grant from Roche, the Netherlands. We thank the data center of the Netherlands Cancer Institute for their data management and logistic support.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Matthijs H. van Gool MD, Tjeerd S. Aukema MD, PhD & Houke M. Klomp MD, PhD

  2. Department of Thoracic Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Tjeerd S. Aukema MD, PhD, Eva E. Schaake MD & Sjaak A. Burgers MD, PhD

  3. Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Tjeerd S. Aukema MD, PhD & Renato A. Valdés Olmos MD, PhD

  4. Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Hendrik J. Teertstra MD

  5. Department of Pathology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Renee van Pel MD

  6. Department of Biometrics, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Harm van Tinteren PhD

  7. Department of Surgery, Kennemer Gasthuis, Haarlem, The Netherlands

    Herman Rijna MD, PhD

  8. Department of Pulmonology, Haga Hospital, The Hague, The Netherlands

    Henk E. Codrington MD

Authors
  1. Matthijs H. van Gool MD
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  2. Tjeerd S. Aukema MD, PhD
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  3. Eva E. Schaake MD
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  6. Renato A. Valdés Olmos MD, PhD
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  7. Hendrik J. Teertstra MD
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  8. Renee van Pel MD
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  9. Sjaak A. Burgers MD, PhD
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  10. Harm van Tinteren PhD
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  11. Houke M. Klomp MD, PhD
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Corresponding author

Correspondence to Houke M. Klomp MD, PhD.

Additional information

The members of the NEL Study Group are listed in the appendix.

Appendix

Appendix

The NEL study group members are as follows: H. M. Klomp, MD, PhD, I. Kappers, MD, M. W. Wouters, MD, (Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands) E. E. Schaake, MD, N. van Zandwijk, MD, PhD, J. A. Burgers, MD, PhD, P. Baas, MD, PhD, M. van den Heuvel, MD, PhD, W. Buikhuisen, MD, (Department of Thoracic Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands); R. A. Valdés Olmos, MD, PhD, T. S. Aukema, MD, PhD, (Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands); H. J. Teertstra, MD, (Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands); D. de Jong, MD, PhD, R. van Pel, MD, (Department of Pathology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands); H. van Tinteren, PhD, O. Dalesio, PhD, (Department of Biometrics, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands); H. Rijna, MD, PhD, (Department of Thoracic Surgery, Kennemer Gasthuis, Haarlem, The Netherlands); C. Weenink, MD, A. Dingemans, MD, PhD, (Department of Pulmonology, Kennemer Gasthuis, Haarlem, The Netherlands); J. Brahim, MD, (Department of Pulmonology, Maastricht Academic Medical Centre, Maastricht, The Netherlands); H. E. Codrington, MD, (Department of Pulmonology, Haga Hospital, The Hague, The Netherlands).

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van Gool, M.H., Aukema, T.S., Schaake, E.E. et al. 18F-Fluorodeoxyglucose Positron Emission Tomography versus Computed Tomography in Predicting Histopathological Response to Epidermal Growth Factor Receptor–Tyrosine Kinase Inhibitor Treatment in Resectable Non-Small Cell Lung Cancer. Ann Surg Oncol 21, 2831–2837 (2014). https://doi.org/10.1245/s10434-014-3791-6

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