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

Our plain-English summary of 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, by P.A. Zucali, E. Lopci, G.L. Ceresoli, et al (Cancer Medicine, 2017).

The study

• Authors: P.A. Zucali, E. Lopci, G.L. Ceresoli, L. Giordano, M. Perrino, G. Ciocia, L. Gianoncelli, E. Lorenzi, M. Simonelli, F. De Vincenzo, L.R. Setti, C. Bonifacio, M. Bonomi, E. Bombardieri, A. Chiti, A. Santoro
• Journal: Cancer Medicine
• Published: 2017;6(10):2287-2296
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

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.

© 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

In plain English

This retrospective study asked whether FDG-PET scans could help predict outcomes in patients with inoperable malignant pleural mesothelioma receiving first-line pemetrexed-based chemotherapy. It reviewed 142 consecutive patients treated at two Italian hospitals, February 2004 to July 2013. All were scanned before treatment and after two cycles. Of these, 77 had talc pleurodesis before chemotherapy and 65 did not. Overall, median progression-free survival was 7.6 months and median overall survival 14.5 months. In both groups, higher uptake on the first scan was associated with shorter survival. Among patients without pleurodesis, some had both a 25% or greater fall in peak uptake (SUVmax) and a 30% or greater fall in total tumor activity (TLG) after two cycles. They had a lower risk of progression (HR 0.31, 95% CI 0.17 to 0.57) and of death (HR 0.52, 95% CI 0.28 to 0.98). In patients with pleurodesis, scan changes were not significantly associated with outcome. The authors concluded that baseline FDG-PET had a prognostic role. They also concluded that early scan changes helped predict outcome in patients not given pleurodesis. The article did not report asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Observational retrospective analysis of a consecutive series of patients, analyzed separately by whether they had talc pleurodesis
• Who was studied: 142 patients with unresectable malignant pleural mesothelioma treated between February 2004 and July 2013 at Humanitas Clinical and Research Center (Rozzano, Milan) and Humanitas Gavazzeni Clinic (Bergamo), Italy. Of these, 77 received talc pleurodesis before chemotherapy and 65 did not.
• Exposure: Not an asbestos exposure study. The study measured FDG-PET values in patients given first-line pemetrexed-based chemotherapy: baseline SUVmax and TLG, and their percentage changes after two cycles. Most patients received carboplatin and pemetrexed, some with bevacizumab. Treatment lasted up to six cycles.
• Main results:
  • All 142 patients: median follow-up 45.2 months; median progression-free survival 7.6 months; median overall survival 14.5 months
  • Patients without pleurodesis (65), multivariate analysis: only baseline SUVmax was significantly associated with overall survival (P = 0.005)
  • Patients without pleurodesis who had both an SUVmax reduction of 25% or more and a TLG reduction of 30% or more after two cycles: reduced risk of disease progression (HR 0.31, 95% CI 0.17 to 0.57, P less than 0.001)
  • The same patients without pleurodesis who had both responses: reduced risk of death (HR 0.52, 95% CI 0.28 to 0.98, P = 0.044)
  • Patients with talc pleurodesis (77): median progression-free survival 8.9 months; median overall survival 17.9 months
  • Patients with talc pleurodesis, multivariate analysis: baseline TLG was significantly associated with both progression-free and overall survival (P less than 0.001)
  • Patients with talc pleurodesis: changes in SUVmax or TLG after two cycles showed no significant association with progression-free or overall survival
• The authors' conclusion: The authors concluded that the study confirmed a prognostic role for baseline FDG-PET in these patients. They also concluded that defining metabolic response after two cycles as an SUVmax reduction of 25% or more and a TLG reduction of 30% or more supported the role of FDG-PET in predicting outcome and treatment response in patients who did not have talc pleurodesis.
• Limitations the authors state:
  • The authors noted that measuring changes in SUVmax or TLG remains challenging in patients with low SUVmax at baseline, whether or not they had pleurodesis

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Unresectable, Pleural Mesothelioma, Pemetrexed (Alimta), Chemotherapy, CT Scan, Modified RECIST (mRECIST), Progression-Free Survival, Overall Survival.

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