18‐FDG PET/CT assessment of basal cell carcinoma with vismodegib

Abstract

The use of 18-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT) in subjects with advanced basal cell carcinoma (BCC) has not been fully explored due to the rarity of disease presentation. This study evaluated PET/CTs from subjects with advanced BCC participating in a phase I dose-escalation clinical trial of vismodegib. Fourteen subjects with BCC were imaged with 18-FDG PET/CT for lesion identification and response categorizing (European Organisation for Research and Treatment for Cancer [EORTC] and PET response criteria in solid tumors [PERCIST] 1.0). Several parameters including metabolic activity of target lesions, site of disease presentation and spread, treatment response, and prognostic significance of metabolic activity following therapy were evaluated. All subjects exhibited at least one hypermetabolic lesion. Most subjects had only four organ systems involved at study enrollment: skin–muscle (93%), lung (57%), lymph nodes (29%), and bone (21%). SUVmax measured across all lesions decreased (median 33%, SD ± 45%) following therapy with metabolic activity normalizing or disappearing in 42% of lesions. No significant difference was observed between EORTC and PERCIST 1.0. Subjects that demonstrated at least a 33% reduction in SUVmax from baseline had a significantly longer progression-free survival (PFS) (median 17 months, 95% confidence interval [CI] ±4 months vs. 9 months, 95% CI ±5 months, P = 0.038) and overall survival (OS) (median 24 months, 95% CI ±4 months vs. 17 months, 95% CI ±13 months, P = 0.019). BCC lesions are hypermetabolic on 18-FDG PET/CT. A decrease in SUVmax was associated with improved PFS and OS. These results further support the incorporation of 18-FDG PET/CT scans in advanced BCC management.

A Semi-Automated Technique Determining the Liver Standardized Uptake Value Reference for Tumor Delineation in FDG PET-CT

“…According to Skougaard et al, PERCIST has clear definitions and therefore more straightforward to use than conventional EORTC criteria [25]. However, even though there were studies comparing PERCIST with conventional criteria (e.g., EORTC) [25], [26], PERCIST has not been proven by prospective studies to be superior in terms of diagnostic accuracy. The readers should be aware of this point when using PERCIST in clinical studies.…”

Evaluating tumor response with FDG PET: updates on PERCIST, comparison with EORTC criteria and clues to future developments

“…So far, however, there only relatively few and mostly small studies comparing RECIST and PERCIST (References: [17] [42] [43] [44] [45] [46] [47] [48] [20] [49] [50] [51] [21] [52] [53] [24] [23] [25] [54] [26] [55] [56]). A meta-analysis published in 2016 identified 6 studies including 268 patients [57].…”

Symptom management and palliative care in advanced basal cell carcinoma

“…In terms of skin cancer, palliative care mainly concerns the control of pain, psychosocial issues related to unaesthetic skin lesion, control of bleeding as well as reducing the possibility of infections. Pharmacological palliative treatment usually involves imiquimod and 5-fluorouracil in a creamy formula [18]. It is recommended to apply a cream formula and occlusal bandages that should be changed five times per week.…”