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Early Metabolic Change after Induction Chemotherapy Predicts Histologic Response and Prognosis in Patients with Esophageal Cancer: Secondary Analysis of a Randomized Trial

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Abstract

Background

Early metabolic response after preoperative induction chemotherapy (IC) appears to predict histologic response and prognosis in esophageal cancer (EC), but the usefulness of this approach needs further development.

Objective

We evaluated metabolic response after one cycle of IC using positron emission tomography (PET) to correlate PET response and outcomes.

Patients and Methods

We retrospectively analyzed PET data from a randomized phase 2 trial (NCT00525915) of chemoradiation and surgery with or without IC for the treatment of EC. PET was performed at baseline, after one cycle of IC, and 5–7 weeks after chemoradiation. The relationship between PET response (≥35% reduction in standardized uptake value [SUV]) after IC and treatment response was analyzed.

Results

In 63 patients who received IC, the mean initial SUVmax prior to treatment was 11.9 ± 8.04 and mean SUVmax after one cycle of IC was 6.47 ± 4.45. The mean SUV reduction after IC was 39.3%. Eleven of 37 PET responders achieved a pathologic complete response (pCR), but only two of 22 PET non-responders did (univariate logistic regression; odds ratio: 4.25, 95% confidence interval: 0.83–21.77; p = 0.08). PET responders to IC had significantly longer overall survival (OS) than PET nonresponders (log-rank p = 0.009). PET response after chemoradiation was not correlated with OS (log-rank p = 0.15).

Conclusion

Early PET response after IC is prognostic, but subsequent PET changes (for example, after chemoradiation) are not prognostic. Early PET response might have the potential of predicting pCR.

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Authors and Affiliations

  1. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Kazuto Harada, Yusuke Shimodaira, Elena Elimova, Quan Lin, Fatemeh G. Amlashi, Dilsa Mizrak Kaya, Anthony Lopez, Mariela A. Blum Murphy, Irene Thomas & Jaffer A. Ajani

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Xuemei Wang

  3. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Tara Sagebiel

  4. Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Manoop S. Bhutani, Jeffrey H. Lee & Brian Weston

  5. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jack A. Roth, Stephen G. Swisher, Wayne L. Hofstetter & Garrett Walsh

  6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Heath D. Skinner & Ritsuko Komaki

  7. Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jane E. Rogers

  8. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Dipen M. Maru

Authors
  1. Kazuto Harada
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  2. Xuemei Wang
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  8. Elena Elimova
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  9. Quan Lin
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  10. Fatemeh G. Amlashi
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  14. Jack A. Roth
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  22. Garrett Walsh
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  23. Jaffer A. Ajani
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Corresponding author

Correspondence to Jaffer A. Ajani.

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Funding

The original trial was supported by Sanofi Oncology, NJ. This research was supported by generous grants from the Caporella, Dallas, Sultan, Park, Smith, Frazier, Oaks, Vanstekelenberg, Planjery, and Cantu families, as well as from the Schecter Private Foundation, Rivercreek Foundation, Kevin Fund, Myer Fund, Dio Fund, Milrod Fund, and The University of Texas MD Anderson Cancer Center (Houston, Texas, USA) multidisciplinary grant program. This research was also supported in part by the National Cancer Institute and Department of Defense awards CA138671, CA172741, CA129926, CA150334 (J.A.A.), and by a grant from the Japan Society for the Promotion of Science Overseas Research Fellowships and Program for Advancing Strategic International Networks to Accelerate the Circulation of Talented Researchers (K.H.).

Conflicts of Interest

The authors have no potential conflicts of interest to disclose.

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Harada, K., Wang, X., Shimodaira, Y. et al. Early Metabolic Change after Induction Chemotherapy Predicts Histologic Response and Prognosis in Patients with Esophageal Cancer: Secondary Analysis of a Randomized Trial. Targ Oncol 13, 99–106 (2018). https://doi.org/10.1007/s11523-017-0540-3

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  • DOI: https://doi.org/10.1007/s11523-017-0540-3

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