TY - JOUR
T1 - Identifying an early indicator of drug efficacy in patients with metastatic colorectal cancer-a prospective evaluation of circulating tumor cells, 18F-fluorodeoxyglucose positron-emission tomography and the RECIST criteria
AU - Ma, B.
AU - King, A. D.
AU - Leung, L.
AU - Wang, K.
AU - Poon, A.
AU - Ho, W. M.
AU - Mo, F.
AU - Chan, C. M.L.
AU - Chan, A. T.C.
AU - Wong, Sze Chuen Cesar
PY - 2017/3/30
Y1 - 2017/3/30
N2 - Background: This study investigated the predictive and prognostic significance of assessing early drug response with both positron-emission computerized tomography (PET-CT) and circulating tumor cells (CTCs) in patients receiving first-line chemotherapy for metastatic colorectal cancer. Patients and methods: Eligible patients had PET-CT and CTC analysis at baseline and 4-6 weeks after starting chemotherapy, and then a CT scan at 10-12 weeks to assess the Response Evaluation Criteria In Solid Tumors (RECIST) response. Early response was defined as achieving a dual-endpoint consisting of PET-CT (30% drop in the sum of maximum standard uptake values- SUVmax-of target lesions) and CTC response (CTC<3 cells/7.5 ml blood) at 4-6 weeks after starting chemotherapy. Results: About 84 patients were enrolled with a median follow-up of 32.9months (95% confidence interval, CI, 24.5months-not reached, NR), and 70 patients (84.3%) completed all assessments. Achieving an early response based on the dual-endpoint was independently associated with progression-free survival (hazard ratio, HR=0.452, 95% CI 0.267-0.765). The median progression-free survival of early responders was 7.41months (95% CI, 6.05-9.11) compared with 5.37 months (95% CI, 4.68-6.24) in non-responders (log-rank, P=0.0167). RECIST response at 10 weeks was independently associated with overall survival (OS) (HR=0.484, 95% CI, 0.275-0.852). Early response based on the dual-endpoint could predict the subsequent RECIST response with a sensitivity, specificity and positive predictive value of 64%, 70% and 74%, respectively. Conclusions: Early response based on both PET-CT and CTC analysis has prognostic and probably predictive significance in patients undergoing first-line chemotherapy for metastatic colorectal cancer. Its utility as a new tool for assessing early drug response should be further validated.
AB - Background: This study investigated the predictive and prognostic significance of assessing early drug response with both positron-emission computerized tomography (PET-CT) and circulating tumor cells (CTCs) in patients receiving first-line chemotherapy for metastatic colorectal cancer. Patients and methods: Eligible patients had PET-CT and CTC analysis at baseline and 4-6 weeks after starting chemotherapy, and then a CT scan at 10-12 weeks to assess the Response Evaluation Criteria In Solid Tumors (RECIST) response. Early response was defined as achieving a dual-endpoint consisting of PET-CT (30% drop in the sum of maximum standard uptake values- SUVmax-of target lesions) and CTC response (CTC<3 cells/7.5 ml blood) at 4-6 weeks after starting chemotherapy. Results: About 84 patients were enrolled with a median follow-up of 32.9months (95% confidence interval, CI, 24.5months-not reached, NR), and 70 patients (84.3%) completed all assessments. Achieving an early response based on the dual-endpoint was independently associated with progression-free survival (hazard ratio, HR=0.452, 95% CI 0.267-0.765). The median progression-free survival of early responders was 7.41months (95% CI, 6.05-9.11) compared with 5.37 months (95% CI, 4.68-6.24) in non-responders (log-rank, P=0.0167). RECIST response at 10 weeks was independently associated with overall survival (OS) (HR=0.484, 95% CI, 0.275-0.852). Early response based on the dual-endpoint could predict the subsequent RECIST response with a sensitivity, specificity and positive predictive value of 64%, 70% and 74%, respectively. Conclusions: Early response based on both PET-CT and CTC analysis has prognostic and probably predictive significance in patients undergoing first-line chemotherapy for metastatic colorectal cancer. Its utility as a new tool for assessing early drug response should be further validated.
KW - Circulating tumor cells
KW - Colorectal cancer
KW - Positron-emission tomography
UR - http://www.scopus.com/inward/record.url?scp=85024829475&partnerID=8YFLogxK
U2 - 10.1093/annonc/mdx149
DO - 10.1093/annonc/mdx149
M3 - Journal article
C2 - 28379285
SN - 0923-7534
VL - 28
SP - 1576
EP - 1581
JO - Annals of Oncology
JF - Annals of Oncology
IS - 7
ER -
