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  • [Eur J Nucl Med Mol Imaging.] 3'-Deoxy-3'-18F-Fluorothymidine and 18F-Fluorodeoxyglucose positron emission tomography for the early prediction of response to Regorafenib in patients with metastatic colorectal cancer refractory to all standard therapies.

    울산의대 / 김정은, 채선영, 김좌훈, 홍용상*

  • 출처
    Eur J Nucl Med Mol Imaging.
  • 등재일
    2019 Jul
  • 저널이슈번호
    46(8):1713-1722. doi: 10.1007/s00259-019-04330-7. Epub 2019 Apr 30.
  • 내용

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    Abstract
    PURPOSE:
    The purpose of this study was to evaluate the value of 3'-deoxy-3'-18F-fluorothymidine (18F-FLT) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for early prediction of standard anatomic response and survival outcomes in patients with metastatic colorectal cancer (mCRC) receiving Regorafenib.

    METHODS:
    Sixty-eight patients with mCRC refractory to standard cytotoxic chemotherapy were enrolled and received Regorafenib (160 mg/day on days 1-21, following a 7-day break). Standard anatomical response was evaluated every 8 weeks. Both scans were performed before and on day 21 of Regorafenib.

    RESULTS:
    Of the 61 patients included in per-protocol analysis, complete response was not observed, but partial response was observed in 8.2% (n = 5), stable disease in 67.2% (n = 41), and progressive disease in 24.6% (n = 15). The objective response rate was 8.2% and disease control rate 75.4%. Five responders (8.2%) and 13 non-responders (21.3%) met the CT and 18F-FLT PET/CT criteria (maximum standardized uptake value decrease ≥ 10.6% for responders). Forty-three (70.5%) exhibited discordant responses on CT and 18F-FLT PET/CT (McNemar test, P < 0.001). At a median follow-up of 8.9 months, median progression-free survival (PFS) and median overall survival (OS) were 3.6 months (95% confidence interval [CI], 3.34-3.80 months) and 8.5 months (95% CI, 6.95-10.10 months), respectively. Comparison of PFS and OS according to 18F-FLT PET/CT response revealed slightly longer PFS (P = 0.015) in responders, but the correlation with OS was not significant. The PET Response Criteria in Solid Tumours (PERCIST) of 18F-FDG PET/CT revealed differences in PFS and OS between partial metabolic response (PMR) and non-PMR (P = 0.048 and P = 0.014, respectively), and between progressive metabolic disease (PMD) and non-PMD (P = 0.189 and P = 0.007, respectively).

    CONCLUSIONS:
    Survival outcome was significantly associated with PERCIST using 18F-FDG PET/CT but the change of 18F-FLT uptake was only slightly associated with PFS. 18F-FDG PET/CT can be used as imaging biomarker to predict clinical outcomes early in patients with mCRC receiving Regorafenib.

     


    Author information

    Kim JE1, Chae SY2, Kim JH1, Kim HJ3, Kim TW1, Kim KP1, Kim SY1, Lee JL1, Oh SJ2, Kim JS2, Ryu JS2, Moon DH2, Hong YS4
    1
    Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
    2
    Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
    3
    Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
    4
    Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. yshong@amc.seoul.kr.

  • 키워드
    18F-fluorodeoxyglucose; 18F-fluorothymidine; Metastatic colorectal cancer; Positron emission tomography; Regorafenib
  • 편집위원

    최근 ASCO 등의 학회에서도 PET을 이용한 약제 효과 및 임상 시험에서 영상을 이용한 검증이 이루어지고 있는 것을 볼 수 있는데 이렇게 PET이 임상에 빠르게 적용될 수 있는 부분이라고 생각됩니다.

    2019-08-30 10:03:34

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