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Total lesion glycolysis (TLG) as an imaging biomarker in metastatic colorectal cancer patients treated with regorafenib

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

This study was performed to evaluate whether fluorine-18 fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) could predict treatment outcome of regorafenib in metastatic colorectal cancer (mCRC).

Methods

Previously treated refractory mCRC patients were enrolled into a prospective biomarker study of regorafenib. For this sub-study, the results of FDG PET/CT scans at baseline and after two cycles of treatment were analyzed. Various metabolic parameters obtained from PET images were analyzed in relation to treatment outcome.

Results

A total of 40 patients were evaluable for PET image analysis. Among various PET parameters, total lesion glycolysis (TLG) measured in the same target lesions for RECIST 1.1 analysis were the most significant in predicting prognosis, with the lowest p-value observed in TLG calculated using the margin threshold of 40 % (TLG40 %). Further analysis using TLG40 % showed significantly longer overall survival (OS) in patients with lower baseline TLG40 % (<151.8) (p = 0.003, median 14.2 vs. 9.1 months in <151.8 and ≥151.8, respectively). Patients showing higher decrease in TLG40 % after treatment showed significantly longer progression-free survival (PFS) (p = 0.001, median 8.0 vs. 2.4 months in %ΔTLG40 % < −9.6 % and ≥ −9.6 %, respectively) and OS (p = 0.002, median 16.4 vs. 9.1 months in %ΔTLG40 % < −9.6 % and ≥ −9.6 %, respectively). The same cutoff could discriminate patients with longer survival among the patients who were under the stable disease category according to RECIST 1.1 (median PFS 8.4 vs. 6.8 months, p = 0.020; median OS 18.3 vs. 11.5 months, p = 0.049).

Conclusion

Measurement of TLG can predict treatment outcome of regorafenib in mCRC.

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, Seoul, 03080, South Korea

    Yoojoo Lim, Sae-Won Han, Kyung-Hun Lee & Tae-You Kim

  2. Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, Seoul, 03080, South Korea

    Ji-In Bang & Jin Chul Paeng

  3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea

    Sae-Won Han & Tae-You Kim

  4. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Geyonggi-do, South Korea

    Jee Hyun Kim

  5. Department of Pathology, Seoul National University Hospital, Seoul, South Korea

    Gyeong Hoon Kang

  6. Department of Surgery, Seoul National University Hospital, Seoul, South Korea

    Seung-Yong Jeong & Kyu Joo Park

  7. Department of Molecular Medicine & Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea

    Tae-You Kim

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  1. Yoojoo Lim
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Corresponding authors

Correspondence to Sae-Won Han or Jin Chul Paeng.

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Funding information

This research was supported by the Seoul National University Hospital Research Fund (grant number: 0320150440), the grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI14C1277), and by the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education, Republic of Korea (grant number: 2009-0093820). Regorafenib was provided by Bayer Pharma AG.

Disclosure

Tae-You Kim has received research funds from Bayer Korea. The other authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee [IRB number: 1307-144-507] and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Yoojoo Lim and Ji-In Bang contributed equally as first authors.

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Lim, Y., Bang, JI., Han, SW. et al. Total lesion glycolysis (TLG) as an imaging biomarker in metastatic colorectal cancer patients treated with regorafenib. Eur J Nucl Med Mol Imaging 44, 757–764 (2017). https://doi.org/10.1007/s00259-016-3577-0

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  • DOI: https://doi.org/10.1007/s00259-016-3577-0

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