Negative-predictive value of SUVmax for Ascertaining the efficacy of osimertinib in EGFR mutation-positive non-small cell lung cancer

Moriyasu Anai; Hiroki Inoue; Koichi Saruwatari; Seitaro Oda; Shinya Shiraishi; Kimitaka Akaike; Kosuke Imamura; Takayuki Jodai; Shinya Sakata; Shinji Iyama; Yusuke Tomita; Hidenori Ichiyasu; Takuro Sakagami

doi:10.1016/j.resinv.2024.09.001

Negative-predictive value of SUVmax for Ascertaining the efficacy of osimertinib in EGFR mutation-positive non-small cell lung cancer

Respir Investig. 2024 Sep 23;62(6):1072-1078. doi: 10.1016/j.resinv.2024.09.001. Online ahead of print.

Affiliations

¹ Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
² Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan. Electronic address: ksaruwat@kuh.kumamoto-u.ac.jp.
³ Department of Diagnostic Radiology, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.

PMID: 39316922
DOI: 10.1016/j.resinv.2024.09.001

Abstract

Background: Fluorine-¹⁸ 2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) is routinely used to stage non-small cell lung cancer (NSCLC). However, whether ¹⁸F-FDG accumulation in primary tumors affects the efficacy of osimertinib in patients with epidermal growth factor receptor (EGFR) mutation-positive NSCLC remains unclear.

Methods: We retrospectively investigated 74 patients with advanced or postoperative recurrent EGFR mutation-positive NSCLC who underwent ¹⁸F-FDG PET/CT and were treated with osimertinib as first-line therapy between September 2018 and March 2023 at Kumamoto University Hospital. The maximum standardized uptake value (SUVmax) of each primary tumor was measured, and the patients were divided into two groups according to the median SUVmax. The effects of SUVmax on progression-free survival (PFS) and overall survival (OS) were assessed using a multivariate Cox proportional hazards model.

Results: The median SUVmax was 8.2 (interquartile range: 5.5-11.4). The median PFS in the high SUVmax group (≥8.2) was significantly shorter than that in the low SUVmax group (<8.2). The respective median PFSs were 11.2 months (95% confidence interval [CI]: 3.1-19.3 months) vs. 22.9 months (95% CI: 12.4-33.4 months) (P = 0.015), although the OS values did not differ significantly. Multivariate analysis showed that a high SUVmax was an independent negative predictive factor for PFS in patients treated with osimertinib (hazard ratio, 2.25; 95% CI: 1.15-4.39, P = 0.017).

Conclusions: High primary-lesion SUVmax in patients with EGFR mutation-positive NSCLC correlated with shorter PFS with first-line osimertinib therapy, suggesting that SUVmax is a useful predictive marker for the antitumor efficacy of osimertinib.

Keywords: Fluorine-(18) 2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography; Non-small cell lung cancer; Osimertinib; Overall survival; Progression-free survival.