Is positron emission tomography (PET) with FDG an early predictor of the RECIST morphological response to chemotherapy in metastatic colorectal cancer patients (mCRC)?

Hendlisz, Alain;Emonts, Patrick;Covas, A;Ameye, Lieveke;Van den Eynde, Marc;et.al.
(2009) 2009 ASCO Annual Meeting — Location: (United States) Orlando, FL (29.May.2009)

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  • Hendlisz, Alain
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  • Emonts, Patrick
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  • Covas, A
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  • Ameye, Lieveke
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  • Van den Eynde, MarcUCLouvain
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Abstract
Background: Reliable early assessment of response would help identify active treatments and avoid unnecessary side effects. Our hypothesis was that FDG-PET metabolic changes 2 weeks after the first dose of chemotherapy predict standard morphological response. Methods: 45 mCRC patients undergoing 1st or 2nd-line chemotherapy are planned to be included in a prospective trial comparing early metabolic changes, as measured by serial FDG-PET, with the standard RECIST- based response assessment using multi-slice CT. A signed informed consent was obtained in all cases. For the lesion-by-lesion analysis, according to the EORTC recommendations, a metabolic response was defined as a ≥ 15% decrease of the standardized FDG uptake (SUVmax) on day 14. A patient was classified as having overall metabolic responsive disease if the majority or all lesions observed on the baseline PET showed a metabolic response, without any progressive lesion ( ≥25% increase). Results: At interim analysis, 28 patients (median age 65.9 yrs) were available for comparative metabolic and morphological analysis of 88 lesions. Mean number of lesions per patient was 3 (range 1–8). Patients received FOLFOX (18), FOLFIRI (9), and capecitabine (1) as first- (19) or second-line (9) treatments. Metabolic assessment showed 49 (56%) responding and 39 (44%) nonresponding lesions. The morphological response rate in metabolically non-responding lesions (5/39; 13%) was lower than in responding lesions (22/49; 45%) (p = 0.001; Fisher's exact test). A mixed metabolic response, combining responding and non-responding lesions within the same patient, was seen in 21/28 (75%) pts. A RECIST response was observed in 6/14 (43%) PET responding and in 0/14 (0%) PET nonresponding patients (p = 0.02; Fisher's Exact test). Updated results of this ongoing trial will be presented. Conclusions: Serial FDG PET seems able to identify non-responding mCRC disease after one course of chemotherapy. No significant financial relationships to disclose.
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Hendlisz, A., Emonts, P., Covas, A., Ameye, L., Paesmans, M., Castany Prado Maria del Rosario, R., Machiels, G., & Van den Eynde, M. (2009). Is positron emission tomography (PET) with FDG an early predictor of the RECIST morphological response to chemotherapy in metastatic colorectal cancer patients (mCRC)? Journal of Clinical Oncology, 27, 2533. https://doi.org/10.1200/jco.2009.27.15s.2533 (Original work published 2009)