Clinical significance of VEGFR-2 and 18F-FDG PET/CT SUVmax pretreatment score in predicting the long-term outcome of patients with locally advanced rectal cancer treated with neoadjuvant therapy - Springer

Clinical significance of VEGFR-2 and 18F-FDG PET/CT SUVmax pretreatment score in predicting the long-term outcome of patients with locally advanced rectal cancer treated with neoadjuvant therapy - Springer

European Journal of Nuclear Medicine and Molecular Imaging

October 2013, Volume 40, Issue 11, pp 1635-1644

Clinical significance of VEGFR-2 and ¹⁸F-FDG PET/CT SUVmax pretreatment score in predicting the long-term outcome of patients with locally advanced rectal cancer treated with neoadjuvant therapy

• Claudio V. Sole,
• Felipe A. Calvo,
• Emilio Alvarez,
• Isabel Peligros,
• Pilar Garcia-Alfonso,
• Carlos Ferrer,
• Enrique Ochoa,
• Rafael Herranz,
• Jose L. Carreras

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Abstract

Purpose

Vascular endothelial growth factor receptor-2 (VEGFR-2), epidermal growth factor receptor-1 (EGFR), and cyclooxygenase-2 (COX-2) stimulate key processes involved in tumor progression and are important targets for cancer drugs. ¹⁸F-FDG maximum standardized uptake value (SUVmax) is a marker of tumor metabolic activity. The purpose of this study was to measure SUVmax combined with VEGFR-2, EGFR and COX-2 proteins in pretreatment tumor biopsies from patients with locally advanced rectal cancer receiving intensive neoadjuvant treatment and to correlate the findings with clinical outcome.

Methods

VEGFR-2, EGFR and COX-2 were measured using the immunoreactive score (IRS). SUVmax (median 8.4) was quantified in tumors with molecular overexpression (IRS ≥3 + SUVmax ≥ 8.4 indicating active tumors; SUVmax <8 .4="" and="" associations="" between="" cox="" disease-free="" explore="" hazards="" inactive="" indicating="" markers="" model="" overall="" p="" proportional="" survival="" the="" to="" tumor="" tumors="" used="" was="">

Results

The study group comprised 38 patients with a median follow-up of 69.3 months (range 4.5 – 92 months). Multivariate analysis showed that active tumors (overexpressing VEGFR-2, high SUVmax) were associated with worse DFS (HR 4.73, 95 % CI 1.18  – 22.17; p = 0.04) and OS (HR 4.28, 95 % CI 1.04 – 20.12; p = 0.05).

Conclusion

Active tumors overexpressing VEGFR-2 are associated with a worse overall outcome in patients with rectal cancer treated with induction chemotherapy followed by pelvic chemoradiation and surgery. The optimal diagnostic cut-off level for this novel biomarker association should be investigated. Evaluation in a clinical trial is required to determine whether selected patients could benefit from a VEGFR-targeting drug.