Early [18]FDG PET/CT scan predicts tumor response in head and neck squamous cell cancer patients treated with erlotinib adjusted per smoking status
Translational RelevanceEvaluation of targeted therapies is urgently needed for the majority of patients with metastatic/recurrent head and neck squamous cell carcinoma (HNSCC) who progress after immunochemotherapy. Erlotinib, a targeted inhibitor of epidermal growth factor receptor pathway, lacks FD...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.939118/full |
| _version_ | 1818494051060547584 |
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| author | Mercedes Porosnicu Mercedes Porosnicu Anderson O’Brien Cox Joshua D. Waltonen Paul M. Bunch Ralph D’Agostino Ralph D’Agostino Thomas W. Lycan Thomas W. Lycan Richard Taylor Dan W. Williams Xiaofei Chen Kirtikar Shukla Brian E. Kouri Tiffany Walker Tiffany Walker Gregory Kucera Gregory Kucera Hafiz S. Patwa Hafiz S. Patwa Christopher A. Sullivan Christopher A. Sullivan J. Dale Browne J. Dale Browne Cristina M. Furdui Cristina M. Furdui |
| author_facet | Mercedes Porosnicu Mercedes Porosnicu Anderson O’Brien Cox Joshua D. Waltonen Paul M. Bunch Ralph D’Agostino Ralph D’Agostino Thomas W. Lycan Thomas W. Lycan Richard Taylor Dan W. Williams Xiaofei Chen Kirtikar Shukla Brian E. Kouri Tiffany Walker Tiffany Walker Gregory Kucera Gregory Kucera Hafiz S. Patwa Hafiz S. Patwa Christopher A. Sullivan Christopher A. Sullivan J. Dale Browne J. Dale Browne Cristina M. Furdui Cristina M. Furdui |
| author_sort | Mercedes Porosnicu |
| collection | DOAJ |
| description | Translational RelevanceEvaluation of targeted therapies is urgently needed for the majority of patients with metastatic/recurrent head and neck squamous cell carcinoma (HNSCC) who progress after immunochemotherapy. Erlotinib, a targeted inhibitor of epidermal growth factor receptor pathway, lacks FDA approval in HNSCC due to inadequate tumor response. This study identifies two potential avenues to improve tumor response to erlotinib among patients with HNSCC. For the first time, this study shows that an increased erlotinib dose of 300 mg in smokers is well-tolerated and produces similar plasma drug concentration as the regular dose of 150 mg in non-smokers, with increased study-specific defined tumor response. The study also highlights the opportunity for improved patient selection for erlotinib treatment by demonstrating that early in-treatment [18]FDG PET/CT is a potential predictor of tumor response, with robust statistical correlations between metabolic changes on early in-treatment PET (4-7 days through treatment) and anatomic response measured by end-of-treatment CT.PurposePatients with advanced HNSCC failing immunochemotherapy have no standard treatment options. Accelerating the investigation of targeted drug therapies is imperative. Treatment with erlotinib produced low response rates in HNSCC. This study investigates the possibility of improved treatment response through patient smoking status-based erlotinib dose optimization, and through early in-treatment [18]FDG PET evaluation to differentiate responders from non-responders.Experimental designIn this window-of-opportunity study, patients with operable HNSCC received neoadjuvant erlotinib with dose determined by smoking status: 150 mg (E150) for non-smokers and 300 mg (E300) for active smokers. Plasma erlotinib levels were measured using mass spectrometry. Patients underwent PET/CT before treatment, between days 4-7 of treatment, and before surgery (post-treatment). Response was measured by diagnostic CT and was defined as decrease in maximum tumor diameter by ≥ 20% (responders), 10-19% (minimum-responders), and < 10% (non-responders).ResultsNineteen patients completed treatment, ten of whom were smokers. There were eleven responders, five minimum-responders, and three non-responders. Tumor response and plasma erlotinib levels were similar between the E150 and E300 patient groups. The percentage change on early PET/CT and post-treatment PET/CT compared to pre-treatment PET/CT were significantly correlated with the radiologic response on post-treatment CTs: R=0.63, p=0.0041 and R=0.71, p=0.00094, respectively.ConclusionThis pilot study suggests that early in-treatment PET/CT can predict response to erlotinib, and treatment with erlotinib dose adjusted according to smoking status is well-tolerated and may improve treatment response in HNSCC. These findings could help optimize erlotinib treatment in HNSCC and should be further investigated.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT00601913, identifier NCT00601913. |
| first_indexed | 2024-12-10T18:01:40Z |
| format | Article |
| id | doaj.art-c47f8d45cae64e029522153138412aa9 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-10T18:01:40Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-c47f8d45cae64e029522153138412aa92022-12-22T01:38:45ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-08-011210.3389/fonc.2022.939118939118Early [18]FDG PET/CT scan predicts tumor response in head and neck squamous cell cancer patients treated with erlotinib adjusted per smoking statusMercedes Porosnicu0Mercedes Porosnicu1Anderson O’Brien Cox2Joshua D. Waltonen3Paul M. Bunch4Ralph D’Agostino5Ralph D’Agostino6Thomas W. Lycan7Thomas W. Lycan8Richard Taylor9Dan W. Williams10Xiaofei Chen11Kirtikar Shukla12Brian E. Kouri13Tiffany Walker14Tiffany Walker15Gregory Kucera16Gregory Kucera17Hafiz S. Patwa18Hafiz S. Patwa19Christopher A. Sullivan20Christopher A. Sullivan21J. Dale Browne22J. Dale Browne23Cristina M. Furdui24Cristina M. Furdui25Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesAtrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United StatesAtrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United StatesDepartment of Otolaryngology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesDepartment of Radiology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesAtrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United StatesDepartment of Biostatistics and Data Science, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesDepartment of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesAtrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United StatesDepartment of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesDepartment of Radiology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesDepartment of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesDepartment of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesDepartment of Radiology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesAtrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United StatesDepartment of Cancer Biology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesAtrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United StatesDepartment of Cancer Biology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesAtrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United StatesDepartment of Otolaryngology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesAtrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United StatesDepartment of Otolaryngology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesAtrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United StatesDepartment of Otolaryngology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesAtrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United StatesDepartment of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United StatesTranslational RelevanceEvaluation of targeted therapies is urgently needed for the majority of patients with metastatic/recurrent head and neck squamous cell carcinoma (HNSCC) who progress after immunochemotherapy. Erlotinib, a targeted inhibitor of epidermal growth factor receptor pathway, lacks FDA approval in HNSCC due to inadequate tumor response. This study identifies two potential avenues to improve tumor response to erlotinib among patients with HNSCC. For the first time, this study shows that an increased erlotinib dose of 300 mg in smokers is well-tolerated and produces similar plasma drug concentration as the regular dose of 150 mg in non-smokers, with increased study-specific defined tumor response. The study also highlights the opportunity for improved patient selection for erlotinib treatment by demonstrating that early in-treatment [18]FDG PET/CT is a potential predictor of tumor response, with robust statistical correlations between metabolic changes on early in-treatment PET (4-7 days through treatment) and anatomic response measured by end-of-treatment CT.PurposePatients with advanced HNSCC failing immunochemotherapy have no standard treatment options. Accelerating the investigation of targeted drug therapies is imperative. Treatment with erlotinib produced low response rates in HNSCC. This study investigates the possibility of improved treatment response through patient smoking status-based erlotinib dose optimization, and through early in-treatment [18]FDG PET evaluation to differentiate responders from non-responders.Experimental designIn this window-of-opportunity study, patients with operable HNSCC received neoadjuvant erlotinib with dose determined by smoking status: 150 mg (E150) for non-smokers and 300 mg (E300) for active smokers. Plasma erlotinib levels were measured using mass spectrometry. Patients underwent PET/CT before treatment, between days 4-7 of treatment, and before surgery (post-treatment). Response was measured by diagnostic CT and was defined as decrease in maximum tumor diameter by ≥ 20% (responders), 10-19% (minimum-responders), and < 10% (non-responders).ResultsNineteen patients completed treatment, ten of whom were smokers. There were eleven responders, five minimum-responders, and three non-responders. Tumor response and plasma erlotinib levels were similar between the E150 and E300 patient groups. The percentage change on early PET/CT and post-treatment PET/CT compared to pre-treatment PET/CT were significantly correlated with the radiologic response on post-treatment CTs: R=0.63, p=0.0041 and R=0.71, p=0.00094, respectively.ConclusionThis pilot study suggests that early in-treatment PET/CT can predict response to erlotinib, and treatment with erlotinib dose adjusted according to smoking status is well-tolerated and may improve treatment response in HNSCC. These findings could help optimize erlotinib treatment in HNSCC and should be further investigated.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT00601913, identifier NCT00601913.https://www.frontiersin.org/articles/10.3389/fonc.2022.939118/fullhead and neck cancererlotinib[18FDG] PET/CTsmokerswomen in science |
| spellingShingle | Mercedes Porosnicu Mercedes Porosnicu Anderson O’Brien Cox Joshua D. Waltonen Paul M. Bunch Ralph D’Agostino Ralph D’Agostino Thomas W. Lycan Thomas W. Lycan Richard Taylor Dan W. Williams Xiaofei Chen Kirtikar Shukla Brian E. Kouri Tiffany Walker Tiffany Walker Gregory Kucera Gregory Kucera Hafiz S. Patwa Hafiz S. Patwa Christopher A. Sullivan Christopher A. Sullivan J. Dale Browne J. Dale Browne Cristina M. Furdui Cristina M. Furdui Early [18]FDG PET/CT scan predicts tumor response in head and neck squamous cell cancer patients treated with erlotinib adjusted per smoking status Frontiers in Oncology head and neck cancer erlotinib [18FDG] PET/CT smokers women in science |
| title | Early [18]FDG PET/CT scan predicts tumor response in head and neck squamous cell cancer patients treated with erlotinib adjusted per smoking status |
| title_full | Early [18]FDG PET/CT scan predicts tumor response in head and neck squamous cell cancer patients treated with erlotinib adjusted per smoking status |
| title_fullStr | Early [18]FDG PET/CT scan predicts tumor response in head and neck squamous cell cancer patients treated with erlotinib adjusted per smoking status |
| title_full_unstemmed | Early [18]FDG PET/CT scan predicts tumor response in head and neck squamous cell cancer patients treated with erlotinib adjusted per smoking status |
| title_short | Early [18]FDG PET/CT scan predicts tumor response in head and neck squamous cell cancer patients treated with erlotinib adjusted per smoking status |
| title_sort | early 18 fdg pet ct scan predicts tumor response in head and neck squamous cell cancer patients treated with erlotinib adjusted per smoking status |
| topic | head and neck cancer erlotinib [18FDG] PET/CT smokers women in science |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.939118/full |
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