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FDG PET/CT after first molecular targeted therapy predicts survival of patients with renal cell carcinoma

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Abstract

Purpose

We investigated prospectively whether 18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) can predict the overall survival (OS) of patients with advanced renal cell carcinoma (RCC) previously treated by molecular targeted therapies.

Methods

Between 2009 and 2016, 81 patients who had received single molecular targeted therapies (43 sorafenib, 27 sunitinib, 8 temsirolimus and others) and were scheduled for second line molecular targeted therapies for advanced RCC were enrolled in this prospective study. FDG PET/CT was performed after first line molecular targeted therapies, the max SUVmax (highest standardized uptake value for each patient) recorded, and its association with OS compared with those of known risk factors. The median follow-up was 15.4 months (range 0.9–97.4 months).

Results

The max SUVmax of the 81 subjects ranged from undetectable to 23.0 (median 7.1). Patients with high max SUVmax had a poor prognosis and multivariate analysis with established risk factors showed that it was an independent predictor of survival (p < 0.001; hazard ratio 1.156; 95% confidence interval 1.080–1.239). Subclassification of patients by max SUVmax showed that the median OS of patients with max SUVmax < 7.0 (39), 7.0–12.0 (30), and ≥ 12.0 (12) were 32.8, 15.2, and 6.0 months, respectively. These differences are statistically significant (< 7.0 versus 7.0–12.0: p = 0.0333, 7.0–12.0 versus ≥ 12.0: p = 0.0235).

Conclusions

The max SUVmax by FDG PET/CT of patients with RCC evaluated after their first molecular targeted therapy predicts OS. FDG PET/CT is a useful “imaging biomarker” for patients with advanced RCC planning sequential molecular targeted therapies.

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Abbreviations

CI:

Confidence interval

FDG PET/CT:

18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography

LDH:

Lactate dehydrogenase

MSKCC:

Memorial Sloan-Kettering Cancer Center

mTOR:

Mammalian target of rapamycin

OS:

Overall survival

PD-1:

Programmed death-1

RCC:

Renal cell carcinoma

SUV:

Standardized uptake value

TKI:

Tyrosine kinase inhibitor

VEGF:

Vascular endothelial cell growth factor

VOI:

Volume of interest

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Acknowledgements

This works was supported in part by Grants-in-Aid for Scientific Research (no. 16K11021) from the Ministry of Education, Culture, Sports, Science and Technology of Japan. The following list represents contributors involved in this study (in alphabetical order): Kitami K, Miura T, Murakami T, Noguchi K, Ohgo Y, Sano F, Takizawa A, Tsuchiya F, and Umemoto S. We thank Trish Reynolds, MBBS, FRACP, from Edanz Group for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Urology, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, 236-0004, Japan

    Noboru Nakaigawa, Keiichi Kondo, Kazuhiro Namura, Daiki Ueno, Hisashi Hasumi, Kazuhide Makiyama, Narihiko Hayashi, Kimito Osaka, Kentaro Muraoka, Koji Izumi, Takashi Kawahara, Jun-ichi Teranishi, Yasuhide Miyoshi, Yasushi Yumura, Hiroji Uemura & Masahiro Yao

  2. Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Tomohiro Kaneta, Ukihide Tateishi, Ryogo Minamimoto & Tomio Inoue

  3. Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan

    Kazuki Kobayashi

  4. Department of Urology, Kanagawa Cancer Center, Yokohama, Japan

    Takeshi Kishida

  5. Department of Urology, Yokohama Minami Kyosai Hospital, Yokohama, Japan

    Ichiro Ikeda

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  1. Noboru Nakaigawa
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Corresponding author

Correspondence to Noboru Nakaigawa.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The study protocol was approved by the Yokohama City University Institutional Review Board. Written informed consent was obtained from all patients.

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Nakaigawa, N., Kondo, K., Kaneta, T. et al. FDG PET/CT after first molecular targeted therapy predicts survival of patients with renal cell carcinoma. Cancer Chemother Pharmacol 81, 739–744 (2018). https://doi.org/10.1007/s00280-018-3542-7

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  • DOI: https://doi.org/10.1007/s00280-018-3542-7

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