TY - JOUR
T1 - Predictive value of 18 F-FDG PET in patients with advanced medullary thyroid carcinoma treated with vandetanib
AU - Werner, Rudolf A.
AU - Schmid, Jan Stefan
AU - Higuchi, Takahiro
AU - Javadi, Mehrbod S.
AU - Rowe, Steven P.
AU - Märkl, Bruno
AU - Aulmann, Christoph
AU - Fassnacht, Martin
AU - Kroiss, Matthias
AU - Reiners, Christoph
AU - Buck, Andreas K.
AU - Kreissl, Michael C.
AU - Lapa, Constantin
N1 - Funding Information:
This project received funding from the European Union’s Framework Programme for Research and Innovation Horizon 2020 (2014–2020, no. 701983) under the Marie Sk1odowska-Curie Grant Agreement. This project also received funding from the German Research Foundation (DFG) and the University of Wuerzburg in the funding program Open Access Publishing. Parts of this cohort received vandetanib while participating in the ZACTIMA trial. No other potential conflict of interest relevant to this article was reported.
Publisher Copyright:
COPYRIGHT © 2018 by the Society of Nuclear Medicine and Molecular Imaging.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Therapeutic options in advanced medullary thyroid carcinoma (MTC) have markedly improved since the introduction of tyrosine kinase inhibitors (TKIs). We aimed to assess the role of metabolic imaging using 18 F-FDG PET/CT shortly before and 3 mo after initiation of TKI treatment. Methods: Eighteen patients with advanced and progressive MTC scheduled for vandetanib treatment underwent baseline 18 F-FDG PET/CT before and 3 mo after TKI treatment initiation. During follow-up, CT scans were obtained every 3 mo and analyzed according to RECIST. The predictive value for estimating progression-free survival (PFS) and overall survival (OS) was examined by investigating the 18 F-FDG SUV mean/max of the metabolically most active lesion, as well as by analyzing clinical parameters (tumor marker doubling times [calcitonin, carcinoembryonic antigen], prior therapies, rearranged-during-transfection mutational status, and disease type). Results: Within a median follow-up of 5.2 y, 9 patients experienced disease progression after a median interval of 2.1 y, whereas the remainder had ongoing disease control (5 with a partial response and 4 with stable disease). Eight of the 9 patients with progressive disease died from MTC after a median of 3.5 y after TKI initiation. A pretherapeutic SUV mean of more than 4.0 predicted a significantly shorter PFS (1.9 y vs. 5.2 y, P = 0.04). Furthermore, sustained high 18 F-FDG uptake at 3 mo with a SUV mean of more than 2.8 tended to portend an unfavorable prognosis, with a PFS of 1.9 y (vs. 3.5 y, P = 0.3). Prolonged carcinoembryonic antigen doubling times were significantly correlated with longer PFS (r = 0.7) and OS (r = 0.76, P, 0.01). None of the other clinical parameters had prognostic significance. Conclusion: Pretherapeutic 18 F-FDG PET/CT provides prognostic information in patients with advanced MTC scheduled for treatment with the TKI vandetanib. A low tumor metabolism with an SUV mean of less than 4.0 before treatment predicts a longer PFS.
AB - Therapeutic options in advanced medullary thyroid carcinoma (MTC) have markedly improved since the introduction of tyrosine kinase inhibitors (TKIs). We aimed to assess the role of metabolic imaging using 18 F-FDG PET/CT shortly before and 3 mo after initiation of TKI treatment. Methods: Eighteen patients with advanced and progressive MTC scheduled for vandetanib treatment underwent baseline 18 F-FDG PET/CT before and 3 mo after TKI treatment initiation. During follow-up, CT scans were obtained every 3 mo and analyzed according to RECIST. The predictive value for estimating progression-free survival (PFS) and overall survival (OS) was examined by investigating the 18 F-FDG SUV mean/max of the metabolically most active lesion, as well as by analyzing clinical parameters (tumor marker doubling times [calcitonin, carcinoembryonic antigen], prior therapies, rearranged-during-transfection mutational status, and disease type). Results: Within a median follow-up of 5.2 y, 9 patients experienced disease progression after a median interval of 2.1 y, whereas the remainder had ongoing disease control (5 with a partial response and 4 with stable disease). Eight of the 9 patients with progressive disease died from MTC after a median of 3.5 y after TKI initiation. A pretherapeutic SUV mean of more than 4.0 predicted a significantly shorter PFS (1.9 y vs. 5.2 y, P = 0.04). Furthermore, sustained high 18 F-FDG uptake at 3 mo with a SUV mean of more than 2.8 tended to portend an unfavorable prognosis, with a PFS of 1.9 y (vs. 3.5 y, P = 0.3). Prolonged carcinoembryonic antigen doubling times were significantly correlated with longer PFS (r = 0.7) and OS (r = 0.76, P, 0.01). None of the other clinical parameters had prognostic significance. Conclusion: Pretherapeutic 18 F-FDG PET/CT provides prognostic information in patients with advanced MTC scheduled for treatment with the TKI vandetanib. A low tumor metabolism with an SUV mean of less than 4.0 before treatment predicts a longer PFS.
UR - http://www.scopus.com/inward/record.url?scp=85046397643&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046397643&partnerID=8YFLogxK
U2 - 10.2967/jnumed.117.199778
DO - 10.2967/jnumed.117.199778
M3 - Article
C2 - 29025983
AN - SCOPUS:85046397643
SN - 0161-5505
VL - 59
SP - 756
EP - 761
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 5
ER -