Open AccessPositron Emission Tomography/Computed Tomography and Biomarkers for Early Treatment Response Evaluation in Metastatic Colon Cancer
Author(s) -
Engelmann Bodil E.,
Loft Annika,
Kjær Andreas,
Nielsen Hans J.,
Gerds Thomas A.,
Benzon Eric v.,
Brünner Nils,
Christensen Ib J.,
Hansson Susanne H.,
Holländer Niels H.,
Kristensen Michael H.,
Löfgren Johan,
Markova Elena,
Sloth Carsten,
Højgaard Liselotte
Publication year - 2014
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2013-0229
Subject(s) - medicine , colorectal cancer , bevacizumab , hazard ratio , response evaluation criteria in solid tumors , positron emission tomography , carcinoembryonic antigen , urokinase receptor , nuclear medicine , capecitabine , oncology , cancer , confidence interval , chemotherapy , progressive disease , plasminogen activator
Background. Treatment options for metastatic colon cancer (mCC) are widening. We prospectively evaluated serial 2‐deoxy‐2‐[18F]fluoro‐ d ‐glucose positron‐emission tomography/computed tomography (PET/CT) and measurements of tissue inhibitor of metalloproteinases‐1 (TIMP‐1), carcinoembryonic antigen (CEA), and liberated domain I of urokinase plasminogen activator receptor (uPAR(I)) for early assessment of treatment response in mCC patients. Methods. Thirty‐three mCC patients scheduled for first‐line chemotherapy with capecitabine and oxaliplatin (CAPOX) and bevacizumab participated; 27 were evaluated by PET/CT before treatment, after one and four treatment series. Morphological and metabolic response was independently assessed according to Response Evaluation Criteria in Solid Tumors and European Organization for Research and Treatment of Cancer PET criteria. Plasma TIMP‐1, plasma uPAR(I), and serum CEA were determined. Results. Metabolic response after one treatment course predicted the ability of CAPOX and bevacizumab to induce morphological response after four treatment series with a sensitivity of 80%, specificity of 69%, and odds ratio of 13.9 (95% confidence interval [CI] 1.9; 182). Early metabolically stable or progressive disease was associated with shorter progression‐free survival (hazard ratio [HR] = 3.2 [CI 1.3; 7.8]). Biomarker levels at early evaluation were associated with shorter OS (TIMP‐1 per unit increase on a log‐2‐transformed ng/mL scale: HR = 2.6 [CI 1.4; 4.9]; uPAR(I) per 25 fmol/mL increase: HR = 1.5 [CI 1.1; 2.1]). Conclusion. This monocentric study demonstrated predictive value of early metabolic PET response and prognostic value of TIMP‐1 and uPAR(I) levels in mCC treated with CAPOX and bevacizumab. Results support investigation of PET/CT, TIMP‐1, and uPAR(I) guided early treatment adaptation in mCC.