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  • Title: Standardized uptake value on (18)F-FDG-PET/CT is a predictor of EGFR T790M mutation status in patients with acquired resistance to EGFR-TKIs.
    Author: Yoshida T, Tanaka H, Kuroda H, Shimizu J, Horio Y, Sakao Y, Inaba Y, Iwata H, Hida T, Yatabe Y.
    Journal: Lung Cancer; 2016 Oct; 100():14-19. PubMed ID: 27597275.
    Abstract:
    BACKGROUND: The development of epidermal growth factor receptor (EGFR) T790M point mutation in exon 20 (T790M) is the most common mechanism of resistance to EGFR tyrosine kinase inhibitors (EGFR-TKIs). The purpose of this study was to determine the association of (18)F-2-fluoro-2-deoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) metrics with T790M status after acquiring resitance to EGFR-TKI resistance. METHODS: We retrospectively reviewed 34 advanced non-small cell lung cancer (NSCLC) patients harboring EGFR mutation who underwent rebiopsy and FDG-PET/CT before rebiopsy. These patients were evaluated for baseline characteristics, initial response to EGFR-TKIs, site of rebiopsy, overall survival, and FDG-PET/CT metrics, such as standardized uptake value (SUV), metabolic tumor volume, and total lesion glycolysis of the rebiopsy site. RESULTS: The median age was 67 years (range, 37-86 years); 19 of the patients (56%) were men. Histologic examination revealed adenocarcinoma in all but one patient, with 20 patients (59%) having stage IIIB and IV disease. Upon initial mutational analyses, the types of EGFR mutation included 17 (50%) deletions in exon 19 and 17 (50%) L858R point mutations in exon 21. At the time of acquired resistance to EGFR-TKIs, T790M mutation was identified in 20 (59%) patients. T790M-positive patients had significantly lower levels of median SUVmean and median SUVmax of the rebiopsy site on FDG-PET/CT, compared with T790M-negative patients (SUVmean: 4.57 vs. 9.91, P=0.0069; SUVmax: 7.26 vs. 16.06, P=0.0054). The survival in patients who acquired T790M after failure of EGFR-TKIs was significantly longer than those without T790M (10.2 mos. vs. 18.6 mos., P<0.05). CONCLUSION: T790M status was associated with lower levels of SUVmean and SUVmax on FDG-PET/CT and significantly longer survival.
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