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FDG-PET identified early response to chemotherapy in rare esophageal cancer

2011 Gastrointestinal Cancers Symposium

FDG-PET imaging detected early metabolic response to chemotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction, information that is useful in determining a patient’s prognosis.

Additionally, patients who did not respond to chemotherapy did not appear to benefit from the addition of radiation, said Florian Lordick, MD, PhD, director of the department of hematology and oncology at Klinikum Braunschweig in Brunswick, Germany.

“We confirmed that PET testing after two weeks of chemotherapy is a very important prognostic tool,” he said. “This approach can help a physician distinguish patients who are responding to chemotherapy from those who are not, and who can therefore be spared from the unnecessary toxicities of treatment that is unlikely to improve their outcome.”

Lordick presented results from MUNICON II, a prospective study of 56 patients with locally advanced adenocarcinoma of the esophagogastric junction, Tuesday during a press conference in advance of the 2011 Gastrointestinal Cancers Symposium.

Researchers used FDG-PET to assess patients’ tumor glucose uptake at baseline and after two weeks of chemotherapy. Those who displayed a metabolic response (n=33) underwent another three months of chemotherapy before surgery. The 23 non-responders underwent salvage preoperative chemoradiation with 32 Gy external beam radiation plus daily 6 mg/m² cisplatin before proceeding to surgery.

Twenty-seven patients (82%) who responded to chemotherapy proceeded to curative surgery vs. 16 (70%) of non-responders. Twelve patients (36%) in the responder group had major histologic remission (<10% residual tumor) compared with six (26%) non-responders.

At a median follow-up of 38 months, median event-free survival was 15.4 months for non-responders while patients in the responder group had yet to reach median event-free survival. Median OS was 18.3 months for non-responders vs. 38 months for responders.

“As expected, in the group of early PET responders, we see a relatively good PFS. This corresponds to the historic results we have obtained during the past 10 years — early response is associated with a better prognosis,” Lordick said. “Unfortunately, in the group of the early PET non-responders, the addition of radiation did not improve survival to a significant extent. The addition of radiation therapy did have some local effect, as we saw in the resection specimens, but it seems that it was not strong enough to change tumor biology in these patients.” – by Jason Harris

For more information:

Disclosure: Dr. Lordick reported no relevant financial disclosures.

PERSPECTIVE

It is a small study so these are preliminary results. We're coming into a new time of molecular diagnostics and PET scan is one example. Currently, we only use on kind of radio nuclei - FDG - but there are a whole series of new radioisotopes coming down the line that are going to allow us look at both markers within the tumor, potentially circulating biomarkers. Potentially it will also allow us to study the relevance of new prognostic factors in malignancy.

– Steven A. Curley, MD
Director, Multidisciplinary Care Center,
University of Texas MD Anderson Cancer Center

Disclosure: Dr. Curley reported no relevant financial disclosures.

Twitter Follow HemOncToday.com on Twitter.

2011 Gastrointestinal Cancers Symposium

FDG-PET imaging detected early metabolic response to chemotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction, information that is useful in determining a patient’s prognosis.

Additionally, patients who did not respond to chemotherapy did not appear to benefit from the addition of radiation, said Florian Lordick, MD, PhD, director of the department of hematology and oncology at Klinikum Braunschweig in Brunswick, Germany.

“We confirmed that PET testing after two weeks of chemotherapy is a very important prognostic tool,” he said. “This approach can help a physician distinguish patients who are responding to chemotherapy from those who are not, and who can therefore be spared from the unnecessary toxicities of treatment that is unlikely to improve their outcome.”

Lordick presented results from MUNICON II, a prospective study of 56 patients with locally advanced adenocarcinoma of the esophagogastric junction, Tuesday during a press conference in advance of the 2011 Gastrointestinal Cancers Symposium.

Researchers used FDG-PET to assess patients’ tumor glucose uptake at baseline and after two weeks of chemotherapy. Those who displayed a metabolic response (n=33) underwent another three months of chemotherapy before surgery. The 23 non-responders underwent salvage preoperative chemoradiation with 32 Gy external beam radiation plus daily 6 mg/m² cisplatin before proceeding to surgery.

Twenty-seven patients (82%) who responded to chemotherapy proceeded to curative surgery vs. 16 (70%) of non-responders. Twelve patients (36%) in the responder group had major histologic remission (<10% residual tumor) compared with six (26%) non-responders.

At a median follow-up of 38 months, median event-free survival was 15.4 months for non-responders while patients in the responder group had yet to reach median event-free survival. Median OS was 18.3 months for non-responders vs. 38 months for responders.

“As expected, in the group of early PET responders, we see a relatively good PFS. This corresponds to the historic results we have obtained during the past 10 years — early response is associated with a better prognosis,” Lordick said. “Unfortunately, in the group of the early PET non-responders, the addition of radiation did not improve survival to a significant extent. The addition of radiation therapy did have some local effect, as we saw in the resection specimens, but it seems that it was not strong enough to change tumor biology in these patients.” – by Jason Harris

For more information:

Disclosure: Dr. Lordick reported no relevant financial disclosures.

PERSPECTIVE

It is a small study so these are preliminary results. We're coming into a new time of molecular diagnostics and PET scan is one example. Currently, we only use on kind of radio nuclei - FDG - but there are a whole series of new radioisotopes coming down the line that are going to allow us look at both markers within the tumor, potentially circulating biomarkers. Potentially it will also allow us to study the relevance of new prognostic factors in malignancy.

– Steven A. Curley, MD
Director, Multidisciplinary Care Center,
University of Texas MD Anderson Cancer Center

Disclosure: Dr. Curley reported no relevant financial disclosures.

Twitter Follow HemOncToday.com on Twitter.

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