THE POSSIBILITY OF PREDICTING LONG-TERM RESULTS OF TARGETED THERAPY IN PATIENTS WITH NSCLC AND MUTATION IN THE EGFR GENE USING PET/CT WITH 18F-FDG
Roitberg G.E.1,3, Sinitsyn V.E.2, Kondratova N.V.3, Strutynskiy V.A.2,3,
Platonova O.E.3, Dorosh J.V.3
1 - N.I. Pirogov Russian National Research Medical University
2 - Lomonosov Moscow State University.
3 - JSC "Medicine". Moscow, Russia.
T |
o study the possibilities of positron emission tomography combined with computed tomography (PET/CT) in predicting long-term results of targeted therapy with tyrosine kinase inhibitors (TKI) in patients with non-small cell lung cancer (NSCLC) and mutation in the EGFR gene based on data obtained at an early stage of treatment.
Material and Methods. The study included 51 patients with NSCLC and an activating mutation in the EGFR gene who were prescribed treatment with gefitinib or erlotinib in combination with taking bevacizumab. PET/CT with the radiopharmaceutical 18F-fluorodeoxyglucose (18F-FDG) was recorded according to the standard procedure on devices Siemens Biograph mct 64 (Germany) and GE Healthcare Discovery PET/CT 710 (USA). The response of the target foci to treatment was calculated according to the criteria RECIST 1.1. and PERCIST 1.0. with the determination of a partial response to treatment, stabilization or progression of the disease. The first control PET/CT examination was performed after 1.5-2 months. from the beginning of treatment. The total duration of observation of the dynamics of PET/ CT was at least 12 months. The first control study was conducted after 1.5-2 months. from the beginning of treatment, the second – after 3-4 months, the third – after 10-11 months and the fourth study – after 12-14 months.
Results. In patients with NSCLC, in whom SULpeak changes in the 1st control study according to PERCIST 1.0 criteria corresponded to a partial response to treatment, the chance of a favorable course of the disease persisted for at least 12 months, whereas the detection of metabolic progression at an early stage of treatment in 75% of patients was associated with rapid progression of morphological the parameters of the tumor according to the RECIST criteria are 1,1, which requires correction of therapy. If the 1st control study shows signs of stabilization of the disease, but there is a moderate (<30%) increase in SULpeak, the risk of metabolic progression further reaches 57%, and with a slight decrease in this indicator does not exceed 5%.
Discussion. Predicting long-term results of targeted therapy in patients with NSCLC and a mutation in the EGFR gene is important for the selection of optimal antitumor therapy. The developed algorithm for the individual prediction of long-term results of antitumor treatment of patients with NSCLC and a mutation in the EGFR gene makes it possible at the earliest stage of treatment to identify a group of patients with an increased risk of further disease progression and timely adjust the therapy.
Conclusions. The developed algorithm for the individual prediction of long-term results of targeted therapy in patients with NSCLC and a mutation in the EGFR gene, which for the first time used the analysis of moderate (<30%) SULpeak changes corresponding to PERCIST 1.0 criteria for disease stabilization, makes it possible to expand the possibilities of predicting long-term treatment results using PET/CT.
Keywords: non-small cell lung cancer (NSCLC), positron emission computed tomography combined with computed tomography (PET/CT), targeted therapy.
Corresponding author: Strutynskiy V.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Roitberg G.E., Sinitsyn V.E., Kondratova N.V., Strutynskiy V.A., Platonova O.E., Dorosh J.V. The possibility of predicting long-term results of targeted therapy in patients with NSCLC and mutation in the EGFR gene using PET/CT with 18f-FDG. REJR 2024; 14(4):69-79. DOI: 10.21569/2222-7415-2024-14-4-69-79.
Received: 01.10.24 Accepted: 20.11.24