FDG-PET May Predict Response to Neoadjuvant Therapy in Pancreatic Cancer

THURSDAY, Sept. 15, 2022 (HealthDay News) -- For patients with borderline resectable/locally advanced (BR/LA) pancreatic ductal adenocarcinoma (PDAC), preoperative fluorodeoxyglucose positron emission tomography (FDG-PET) may predict pathologic response to neoadjuvant therapy (NAT), according to a study published online Sept. 8 in the Journal of the National Comprehensive Cancer Network.

Amro M. Abdelrahman, M.B.B.S., from the Mayo Clinic in Rochester, Minnesota, and colleagues reviewed 202 patients with resected BR/LA PDAC who underwent NAT with FDG-PET within 60 days of resection to examine the role of preoperative FDG-PET for predicting NAT response and survival. Post-NAT metabolic (FDG-PET) and biochemical (CA 19-9) responses were compared as preoperative predictors of pathologic responses.

The researchers found that 58 percent of patients had optimization of CA 19-9 levels post-NAT. In 51 percent and 38 percent of patients, major metabolic and pathologic responses were identified, respectively. The median recurrence-free survival (RFS) was 21 months, and overall survival (OS) was 48.7 months. For predicting pathologic response, metabolic response was superior to biochemical response. The only univariate preoperative predictor of OS was metabolic response (odds ratio, 0.25), and this was highly correlated with pathologic response compared with biochemical response alone. Metabolic response was the single largest independent preoperative predictor of pathologic response (odds ratio, 43.2) and of RFS and OS (hazard ratios, 0.37 and 0.21, respectively) after multivariate adjustment.

"With FDG-PET, we can tell patients how the cancer responded to NAT before going through major surgical resection," Abdelrahman said in a statement.

One author disclosed financial ties to the medical device and biopharmaceutical industries.

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