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. 2016 May 3;11(5):e0149955.
doi: 10.1371/journal.pone.0149955. eCollection 2016.

Total Body Metabolic Tumor Response in ALK Positive Non-Small Cell Lung Cancer Patients Treated with ALK Inhibition

Gerald S M A Kerner  1 , Michel J B Koole  2 , Alphons H H Bongaerts  2 , Jan Pruim  2   3 , Harry J M Groen  1 ; CTMM Air Force Consortium
Affiliations

Total Body Metabolic Tumor Response in ALK Positive Non-Small Cell Lung Cancer Patients Treated with ALK Inhibition

Gerald S M A Kerner et al. PLoS One. .

Abstract

Background: In ALK-positive advanced NSCLC, crizotinib has a high response rate and effectively increases quality of life and survival. CT measurement of the tumor may insufficiently reflect the actual tumor load changes during targeted therapy with crizotinib. We explored whether 18F-FDG PET measured metabolic changes are different from CT based changes and studied the impact of these changes on disease progression.

Methods: 18F-FDG PET/CT was performed prior to and after 6 weeks of crizotinib treatment. Tumor response on CT was classified with RECIST 1.1, while 18F-FDG PET response was assessed according to the 1999 EORTC recommendations and PERCIST criteria. Agreement was assessed using McNemars test. During follow-up, patients received additional PET/CT during crizotinib treatment and second generation ALK inhibition. We assessed whether PET was able to detect progression earlier then CT.

Results: In this exploratory study 15 patients were analyzed who were treated with crizotinib. There was a good agreement in the applicability of CT and 18F-FDG PET/CT using the EORTC recommendations. During first line crizotinib and subsequent second line ALK inhibitors, PET was able to detect progression earlier then CT in 10/22 (45%) events of progression and in the others disease progression was detected simultaneously.

Conclusion: In advanced ALK positive NSCLC PET was able to detect progressive disease earlier than with CT in nearly half of the assessments while both imaging tests performed similar in the others.

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Conflict of interest statement

Competing Interests: The CTMM Air Force Consortium is a private/public consortium with involvement of academia, private companies, and the government. It is not a commercial source of funding. Gerald Kerner was funded by CTMM consortium to perform the research project (translational and imaging research in lung cancer) that is a part of his thesis. The authors are entitled to publish all his work and share all their data publicly. No consultancy, patents, or products in development are involved. All together, this has no impact to the authors’ adherence to all the PLOS ONE policies on sharing data and materials. All authors declared not having any competing interests.

Figures

Fig 1
Fig 1. Change in percentage between baseline and after 6 weeks of treatment with crizotinib assessed using SUVmax (1A, N = 13), SUVpeak (1B, N = 10) and RECIST (1C, N = 13).
Fig 2
Fig 2. 18F-FDG maximum intensity projection of patient 2 and 8 prior to (A, B) and after 6 weeks of treatment with crizotinib (C, D).
Scale is from 0–15 SUV. These images illustrate the clinically dramatic decrease in 18F-FDG uptake, with both patients having a PMR according to both PERCIST criteria and the EORTC recommendations.
See this image and copyright information in PMC

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