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Prognostic and predictive role of [18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with unresectable malignant pleural mesothelioma (MPM) treated with up-front pemetrexed-based chemotherapy.


ABSTRACT: The aim of this study was to evaluate the role of metabolic parameters analyzed at baseline and at interim FDG-PET in predicting disease outcome in unresectable MPM patients receiving pemetrexed-based chemotherapy. A consecutive series of MPM patients treated between February 2004 and July 2013 with first-line pemetrexed-based chemotherapy, and evaluated by FDG-PET and CT scan at baseline and after two cycles of chemotherapy, was reviewed. Best CT scan response was assessed according to modified RECIST criteria. Progression-free survival (PFS) and overall survival (OS) were correlated with FDG-PET parameters, such as maximum standardized uptake value (SUVmax ), total lesion glycolysis (TLG), and percentage changes in SUVmax (?SUV) and TLG (?TLG). Overall, 142 patients were enrolled; 77 (54%) received talc pleurodesis before chemotherapy. Baseline SUVmax and TLG showed a statistically significant correlation with PFS and OS (P < 0.05) in both group of patients (treated and untreated with pleurodesis). In 65 patients not receiving pleurodesis, SUVmax reduction ?25% (?SUV ? 25%) and TLG reduction ?30% (?TLG ? 30%) were significantly associated with longer PFS (P < 0.05). Patients showing both ?SUV ? 25% and ?TLG ? 30% responses had a significant reduction in the risk of disease progression (HR:0.31, P < 0.001) and death (HR:0.52, P = 0.044). Neither ?SUV nor ?TLG showed similar association with survival outcomes in patients treated with pleurodesis. Our study confirmed the prognostic role of baseline FDG-PET in a large series of MPM patients treated with first-line pemetrexed-based chemotherapy. Moreover, use of ?SUV ? 25% and ?TLG ? 30% as cut-off values to define early metabolic response supported the role of FDG-PET in predicting disease outcome and treatment response in patients not receiving pleurodesis.

SUBMITTER: Zucali PA 

PROVIDER: S-EPMC5633593 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Prognostic and predictive role of [<sup>18</sup> F]fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with unresectable malignant pleural mesothelioma (MPM) treated with up-front pemetrexed-based chemotherapy.

Zucali Paolo Andrea PA   Lopci Egesta E   Ceresoli Giovanni Luca GL   Giordano Laura L   Perrino Matteo M   Ciocia Gianluigi G   Gianoncelli Letizia L   Lorenzi Elena E   Simonelli Matteo M   De Vincenzo Fabio F   Setti Lucia Rebecca LR   Bonifacio Cristiana C   Bonomi Maria M   Bombardieri Emilio E   Chiti Arturo A   Santoro Armando A  

Cancer medicine 20170921 10


The aim of this study was to evaluate the role of metabolic parameters analyzed at baseline and at interim FDG-PET in predicting disease outcome in unresectable MPM patients receiving pemetrexed-based chemotherapy. A consecutive series of MPM patients treated between February 2004 and July 2013 with first-line pemetrexed-based chemotherapy, and evaluated by FDG-PET and CT scan at baseline and after two cycles of chemotherapy, was reviewed. Best CT scan response was assessed according to modified  ...[more]

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