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FDG-PET metrics in advanced non-small cell lung cancer (NSCLC): a review and meta-analysis

  • Meta-Analysis
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Abstract

Purpose

To provide a systematic review and meta-analysis of published literature characterizing the prognostic value of pre-treatment, volume-based FDG-PET metrics in patients with advanced NSCLC.

Methods

We conducted a systematic PubMed search to identify studies describing the prognostic value of volume-based PET metrics (total metabolic tumor volume [MTV] and/or total lesion glycolysis [TLG]) obtained prior to initiation of first-line systemic therapy for advanced NSCLC. Clinical endpoints examined were progression-free survival (PFS) and overall survival (OS). Hazard ratios for PFS and OS were taken directly from the original reports when available or extracted from survival curves. Inverse variance meta-analyses were performed to assess associations between PET metrics and clinical outcomes.

Results

Thirteen publications including 1,047 patients were included in our analysis. Patients from at least 9 studies received chemotherapy, at least 4 studies utilized targeted therapy, and only 1 study included patients treated with immunotherapy.

Random effects models demonstrated that high MTV is significantly associated with inferior PFS (HR 2.97, 95% CI 2.21–4.00, p < 0.001) and inferior OS (HR 2.73, 95% CI 2.18–3.41, p < 0.001). High TLG is also significantly associated with inferior PFS (HR 2.13, 95% CI 1.56–2.91, p < 0.001) and inferior OS (HR 2.06, 95% CI 1.75–2.44, p < 0.001).

Conclusion

Baseline PET metrics are powerful prognostic factors for advanced NSCLC patients who are treated with chemotherapy or targeted therapy. Further examination of the prognostic value of PET metrics for patients who receive first-line immunotherapy is warranted.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by RefleXion Medical, Inc. (Hayward, CA, USA).

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Authors and Affiliations

  1. Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA

    Aviva C. Berkowitz & Nitin Ohri

  2. Department of Medical Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA

    Balazs Halmos & Haiying Cheng

  3. RefleXion Medical, Inc., Hayward, CA, USA

    Cal Huntzinger

Authors
  1. Aviva C. Berkowitz
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  2. Balazs Halmos
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  3. Haiying Cheng
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  4. Cal Huntzinger
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Corresponding author

Correspondence to Aviva C. Berkowitz.

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Conflict of interest

Dr. Berkowitz has no relevant financial or non-financial interests to disclose. Dr. Halmos is a consultant at AstraZeneca, Boehringer Ingelheim, Genentech/Roche, Pfizer, Lilly, Foundation Medicine, Guardant Health, Takeda, Novartis, Merck, Bristol-Myers Squibb, Spectrum Pharmaceuticals and TPT Therapeutics. Dr. Cheng is a consultant at AstraZeneca and Bayer, and she received research grants from Roche/Genentech, Spectrum Pharmaceuticals, and Vaccinex. Mr. Huntzinger is an employee at RefleXion Medical, where he also has stock and stock options. Dr. Ohri is a consultant at Merck and AstraZeneca.

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Berkowitz, A.C., Halmos, B., Cheng, H. et al. FDG-PET metrics in advanced non-small cell lung cancer (NSCLC): a review and meta-analysis. Clin Transl Imaging 11, 381–387 (2023). https://doi.org/10.1007/s40336-023-00542-y

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  • DOI: https://doi.org/10.1007/s40336-023-00542-y

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