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Early PET response predicted increased survival after chemotherapy in sarcoma patients
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Patients with soft tissue sarcoma who achieved an early PET response after a single cycle of neoadjuvant chemotherapy experienced significantly longer survival compared with those who did not achieve an early PET response, according to study results.
The value of neoadjuvant therapy in patients with soft tissue sarcoma is controversial due to its association with significant toxicity and limited survival benefits, according to background information in the study.
Still, previous studies demonstrated 2[18F]fluoro-2-deoxy-d-glucose (18F-FDG) PET/CT could determine pathologic response after the initial dose of chemotherapy. Those findings led researchers in the current study to investigate whether a significant PET response after one round of chemotherapy could predict long-term survival in soft tissue sarcoma patients.
Fritz C. Eilber, MD, an associate professor at UCLA’s Jonsson Comprehensive Cancer Center, and colleagues enrolled 57 patients with primary, nonmetastatic soft tissue sarcoma in the study.
All patients underwent a baseline PET scan before chemotherapy to measure tumor metabolism.
Researchers performed early follow-up PET scans on 39 of the patients after their initial round of chemotherapy. A univariate analysis showed that a 26% reduction in tumor metabolic activity from baseline scan to early follow-up was a significant predictor of survival (HR=0.27; 95% CI, 0.08-0.95).
“We can now identify whether patients are getting the right chemotherapy very quickly,” Eilber said in a press release. “This is vital because patients want to know if the drugs are working and what that says about their ultimate outcome.”
“The study suggests PET allows survival predictions after the initial cycle of neoadjuvant chemotherapy and might therefore potentially serve as an early endpoint biomarker,” Eilber and colleagues wrote. “Such information cannot be derived from CT scanning based on serial tumor size measurements.
The findings demonstrate a need for additional prospective trials to determine whether PET response early after the start of treatment can help guide therapeutic decisions, the researchers wrote.
The ability to assess treatment response early during therapy could guide management decisions, ensuring patients who respond to neoadjuvant therapy continue to receive it while those who do not respond could undergo immediate surgery, the researchers wrote.
Early PET response also may reduce the length of ineffective chemotherapy, potentially reducing costs and the number of hospitalizations due to side effects, they wrote.
Disclosure: One researcher reported a commercial research grant from Bayer and Philips. The other researchers report no relevant financial disclosures.
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