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Non–small cell lung cancer (NSCLC) is a heterogeneous disease comprising different histologic and molecular subtypes with distinct clinical characteristics, outcomes, and prognosis.
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PET has an established role in the diagnosis, staging, and monitoring of therapeutic response in patients with NSCLC.
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Early therapeutic response on PET is associated with improved outcomes in patients receiving targeted therapies.
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Newer PET tracers have been developed in hopes of improving the sensitivity and
Genomic Characterization of Lung Cancer and Its Impact on the Use and Timing of PET in Therapeutic Response Assessment
Section snippets
Key points
The genomic landscape of non–small cell lung cancer
NSCLC accounts for 85% of all lung cancer cases and comprises 3 major histologic subtypes with the most common being adenocarcinoma followed by squamous cell carcinoma and less commonly large cell carcinoma.1 Most cases of lung cancer are related to tobacco smoking; however, approximately 10% to 20% of cases occur in patients who have never smoked, and the declining rates of smoking equals a proportional increase of incidence among never smokers.3, 4 Smoking-related lung cancer has a
Response assessment criteria in lung cancer
Early and robust evaluation of tumor response in lung cancer is needed to avoid unnecessary side effects of ineffective treatment and delay switching to a more efficacious alternative therapy.2, 47 Multiple guidelines have been developed to assess therapeutic response in clinical trials as a potential surrogate for survival, such as the World Health Organization (WHO) criteria (1979), Response Evaluation Criteria in Solid Tumors (RECIST) 2000, and RECIST 1.1 (2009). RECIST criteria, a
PET detection of oligoprogressive disease
The most common utility of PET in the clinical setting thus far is in detecting oligometastatic disease, which occurs early in the metastatic process defined by a small number of new metastases with limited progression of disease. It is also useful in determining the best site to biopsy, especially in cases where tumor recurrence is uncertain. Increasingly, patients with EGFR mutation-positive and ALK rearranged NSCLC with oligoprogressive disease are being treated with a combination of local
Summary
In the last few years, substantial progress has been made in the discovery of genomic alterations of lung cancer, illuminating clinically significant somatic mutations and enabling further refinement in the subclassification of NSCLC. The identification of oncogenic drivers together with molecular targeted therapies and newer immunotherapies have changed the way patients with lung cancer are treated, with considerable progress still to be made therapeutically. Functional imaging with PET can
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Cited by (1)
The Value of the Standardized Uptake Value (SUV) and Metabolic Tumor Volume (MTV) in Lung Cancer
2022, Seminars in Nuclear MedicineCitation Excerpt :For example, retrospective analysis of 89 primarily stage III NSCLC patients undergoing definitive chemoradiotherapy in two prospective trials, found the MTV, whether of nodal, primary or total disease burden, was not predictive of survival suggesting that efficacy of treatment may be more important than baseline disease burden in patients with disease that is treated with curative intent.51 Response to targeted therapies is also qualitatively different to those observed with chemotherapy or radiotherapy with often rapid and marked reduction in FDG-avidity with the onset of treatment, reflecting abrogation of signaling through pathways that lead to metabolic reprogramming.52 Collectively, these results emphasize the need for studies in homogeneously treated patients in addition to evaluation of differing subtypes of lung cancer.
Disclosure Statement: No relevant conflicts of interest.