FDG-PET for predicting efficacy of EGFR-tyrosine kinase inhibitors in lung cancer

Abstract

Non-small cell lung cancer (NSCLC) is the major cause of cancer-related deaths worldwide. Recent advances in molecular biology have resulted in the clinical use of several molecularly targeted drugs, which usually exhibit cytostatic antitumor activity, to improve the survival of NSCLC patients. The epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) gefitinib and erlotinib have been approved for the treatment of NSCLC, and several phase III trials have demonstrated that sensitizing EGFR mutations are biomarkers for predicting a favorable clinical outcome of NSCLC patients treated with the EGFR-TKIs. The Response Evaluation Criteria in Solid Tumors is generally used to assess the therapeutic response to antitumor drugs based on the morphological changes in tumor size as evaluated by computed tomography or magnetic resonance imaging. However, such assessment may not always reflect the treatment efficacy of cytostatic drugs, such as EGFR-TKIs. In this regard, functional imaging methods, including ¹⁸F-fluorodeoxyglucose measured by positron emission tomography (FDG-PET), are potentially beneficial. An increasing body of evidence indicates the usefulness of FDG-PET to predict treatment efficacy for NSCLC patients treated with EGFR-TKIs. In this review, we summarize the current understanding of the potential role of FDG-PET in the clinical use of EGFR-TKIs for NSCLC.

Keywords: Non-small cell lung cancer; ¹⁸F-fluorodeoxyglucose measured by positron emission tomography; Epidermal growth factor receptor mutation; Gefitinib; Erlotinib; Survival; Biomarker

Core tip: Molecularly targeted drugs including epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), which usually exhibit cytostatic antitumor activity, have emerged for the treatment of non-small cell lung cancer. The Response Evaluation Criteria in Solid Tumors is generally used to assess the therapeutic response based on the morphological changes in tumor size as evaluated by computed tomography or magnetic resonance imaging. However, such assessment may not always reflect the clinical outcome of cytostatic drugs, such as EGFR-TKIs. In this regard, 18F-fluorodeoxyglucose measured by positron emission tomography (FDG-PET) is potentially beneficial. Here we summarize the role of FDG-PET to predict the treatment efficacy in NSCLC treated with EGFR-TKIs.