Flare Response versus Disease Progression in Patients with Non-small Cell Lung Cancer.Flare Response versus Disease Progression in Patients with Non-small Cell Lung Cancer

Al-Nabhani, Khalsa; Syed, Rabbani; Haroon, Athar; Almukhailed, Omar; Bomanji, Jamshed

doi:10.3941/jrcr.v6i11.1109

Cited by 7 publications

(4 citation statements)

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“…The development of bone metastases is common in nonsmall cell lung cancer (NSCLC) as about 20-40 percent of patients will be diagnosed with metastatic bone lesions at some point during the course of their disease [1]. In the majority of cases these lesions are osteolytic, but osteoblastic bone metastases in NSCLC have been reported, primarily in adenocarcinoma [2,3]. The finding of new metastatic (bone) lesions will generally prompt a change of treatment.…”

Section: Introductionmentioning

confidence: 99%

A Flare for the Unexpected: Bone Flare as Response to Tyrosine Kinase Inhibitor Treatment in a Lung Cancer Patient

Bondt

Snoeckx

Raskin

2020

Journal of the Belgian Society of Radiology

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We report the case of a 72-year-old female never-smoker with stage IV endothelial growth factor receptor (EGFR) mutated lung adenocarcinoma. This patient was started on first line tyrosine kinase inhibitor (TKI) and seemingly developed new bone metastases under this treatment. As there was a remarkable discrepancy between the partial response seen in the primary tumor and non-osseous metastatic locations, the possibility of a bone flare phenomenon was considered. In this case report, we demonstrate that new bony lesions are not always synonymous with disease progression.

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Section: Introductionmentioning

confidence: 99%

A Flare for the Unexpected: Bone Flare as Response to Tyrosine Kinase Inhibitor Treatment in a Lung Cancer Patient

Bondt

Snoeckx

Raskin

2020

Journal of the Belgian Society of Radiology

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“…Increased FDG uptake was thought to represent osteoblastic activity after an effective therapy [35,36]. This phenomenon had been relatively rare, but recently many cases have been reported, showing that bone flare phenomena are observed on FDG-PET/CT not only for patients with breast cancer, but also for those with non-small cell lung cancer (NSCLC), following the use of anti-VEGF antibodies such as bevacizumab and erlotinib [37][38][39]. The findings of these studies suggest that the addition of immune flare response to monoclonal antibodies on osteoblastic changes may lead to a higher incidence of false positive FDG uptake.…”

Section: False Positive Images Resulting From Monoclonal Antibody Therapymentioning

confidence: 99%

Imaging Assessment of Tumor Response in the Era of Immunotherapy

et al. 2021

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Assessment of tumor response during treatment is one of the most important purposes of imaging. Before the appearance of immunotherapy, response evaluation criteria in solid tumors (RECIST) and positron emission tomography response criteria in solid tumors (PERCIST) were, respectively, the established morphologic and metabolic response criteria, and cessation of treatment was recommended when progressive disease was detected according to these criteria. However, various types of immunotherapy have been developed over the past 20 years, which show novel false positive findings on images, as well as distinct response patterns from conventional therapies. Antitumor immune response itself causes 18F-fluorodeoxyglucose (FDG) uptake in tumor sites, known as “flare phenomenon”, so that positron emission tomography using FDG can no longer accurately identify remaining tumors. Furthermore, tumors often initially increase, followed by stability or decrease resulting from immunotherapy, which is called “pseudoprogression”, so that progressive disease cannot be confirmed by computed tomography or magnetic resonance imaging at a single time point. As a result, neither RECIST nor PERCIST can accurately predict the response to immunotherapy, and therefore several new response criteria fixed for immunotherapy have been proposed. However, these criteria are still controversial, and also require months for response confirmation. The establishment of optimal response criteria and the development of new imaging technologies other than FDG are therefore urgently needed. In this review, we summarize the false positive images and the revision of response criteria for each immunotherapy, in order to avoid discontinuation of a truly effective immunotherapy.

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“…In 1999 European Organization for Research and Treatment of Cancer (EORTC) published guidelines for measurement of clinical and subclinical tumor response using FDG-PET [34]. In 2009 a new set of guidelines Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) [29,35] was proposed and even though the acceptance of these criteria have been quite slow, recent publications support the use of PERCIST over the more simple EORTC criteria [36,37,38,39,40,41,42,43,44,45,46,47,48,49]. This study applied, for the first time in a PET/MR setting, PERCIST measurement.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that SUV values obtained from tumor areas typically decrease following effectively intervention in solid tumors. However, studies have described a temporary increase in SUV, a flare, shortly after chemotherapy administration due to cell swelling, fibroblasts and macrophage infiltration despite therapeutic effect [13,42,43]. Thus, it is currently a widely hold opinion that differentiating between increased FDG uptake due to flare and true disease progression may not be possible early after chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Very Early Response Evaluation by PET/MR in Patients with Lung Cancer—Timing and Feasibility

Langer

Johannesen

et al. 2019

Diagnostics

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Purpose: With the increasing number of therapy options available for patients with lung cancer, early response evaluation is needed. We performed this pilot study to assess the feasibility of early, repeated Positron emission tomography-magnetic resonance (PET/MR), the impact of timing and the capability for response prediction in lung tumors during chemotherapy. Methods: Patients with stage IV non-small cell lung cancer referred for chemotherapy were prospectively recruited. Fluorine-18-Fluorodeoxyglucose(18F-FDG)-PET/MR scans were performed prior to, during and after the first or second cycle of chemotherapy. Primary tumors were defined on all scans and size, FDG-uptake and apparent diffusion coefficient (ADC) were measured. Early response was described over time and a Standard Linear Mixed Model was applied to analyze changes over time. Results: 45 FDG-PET/MR scans were performed in 11 patients. Whereas the overall changes measured by ADC did not change significantly, there was an overall significant decrease in FDG-uptake from pre to post treatment scans. There was no difference in the FDG-uptake measured 1 or 3 weeks after therapy, but uptake measured 2 weeks after therapy differed from measurements at week 3. Changes measured in patients scanned during the first treatment cycle appeared more pronounced than during the second cycle. Conclusions: This pilot study indicates that response evaluation shortly after initiation of chemotherapy appears concordant with later evaluation and probably more reliable than evaluation midway between cycles. Responses during or after the first cycle of chemotherapy rather than during subsequent cycles are likely to be more readily measured.

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Flare Response versus Disease Progression in Patients with Non-small Cell Lung Cancer.Flare Response versus Disease Progression in Patients with Non-small Cell Lung Cancer

Cited by 7 publications

References 0 publications

A Flare for the Unexpected: Bone Flare as Response to Tyrosine Kinase Inhibitor Treatment in a Lung Cancer Patient

A Flare for the Unexpected: Bone Flare as Response to Tyrosine Kinase Inhibitor Treatment in a Lung Cancer Patient

Imaging Assessment of Tumor Response in the Era of Immunotherapy

Very Early Response Evaluation by PET/MR in Patients with Lung Cancer—Timing and Feasibility

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