Elsevier

PET Clinics

Volume 12, Issue 1, January 2017, Pages 53-62
PET Clinics

Molecular Imaging and Precision Medicine in Lung Cancer

https://doi.org/10.1016/j.cpet.2016.08.008Get rights and content

Section snippets

Key points

  • PET is essential to accurately stage patients with potentially curable lung cancer.

  • PET plays a central role in precision medicine by helping to noninvasively assess molecular pathobiology and genetic make-up of disease so that appropriate therapy is selected and started.

  • PET is key for subsequent treatment strategy of patients with lung cancer, including monitoring of therapy response, detection of recurrence, and prediction of patient outcomes.

Precision medicine and lung cancer

Lung cancer is the second most commonly diagnosed malignancy in men and women, estimated to account for approximately 224,390 new cases and 158,080 deaths in 2016 according to the American Cancer Society.1 Although localized disease may be curable, metastatic lung cancer is the leading cause of cancer-related death. Indeed, it is estimated that one out of four cancer-related deaths are related to manifestations of metastatic lung cancer.1

Lung cancer is heterogeneous morphologically and

PET/CT Imaging in initial staging of the patient with lung cancer

FDG-PET/CT is helpful to (1) characterize a morphologically indeterminate solitary pulmonary nodule (SPN); (2) guide biopsy to the site of most aggressive, intensely FDG-avid, disease; and (3) evaluate disease extent including primary disease, lymph nodes, and distant metastases.

An SPN is a common incidental finding on anatomic imaging done as a part of clinical practice.6 The differential diagnoses are numerous and include benign and malignant causes, such as infection, inflammation, and lung

PET-based molecular imaging and precision medicine in the subsequent treatment strategy of the patient with lung cancer

Precision medicine aims to classify patients into subgroups by integrating molecular pathobiology and genetic make-up of disease with clinical manifestations to diagnose, stage, predict treatment response, and suggest patient outcome.32 Once those who will benefit are identified, tailored “preventive or therapeutic interventions” can be used to avoid the expense and toxicity of futile treatment given to those who will not respond. The ultimate goal is to offer the right treatment, to the right

PET as a predictive biomarker of response to lung cancer therapy

Limitations and pitfalls of morphologic imaging criteria (ie, World Health Organization, Response Evaluation Criteria in Solid Tumours [RECIST]) to assess tumor response or progression after therapy have become evident over the years. Some of these shortcomings are related to issues of reproducibility and that results do not correlate with patient outcomes in certain tumor types. Other limitations are therapy specific, because morphologic response criteria were designed to monitor the cytolytic

PET as a biomarker of prognosis in lung cancer

Several studies have been conducted to determine the prognostic value of FDG-PET in lung cancer. Understanding the prognostic value of FDG metabolism in these lesions facilitates the identification of patients at high risk of early disease progression irrespective of their clinical stage at diagnosis. This information can then be used early during the clinical management of the patient with lung cancer to personalize postsurgical therapy in those with early stage disease, but highly

Summary

PET/CT is a sensitive molecular imaging technique with a major role in the precision medicine algorithm of the patient with lung cancer. On one hand, it provides anatomofunctional insight during diagnosis, staging, and restaging. On the other hand, it is a biomarker of tumoral heterogeneity that directs the selection of the most appropriate treatment, and predicts response early and accurately during the course of cytotoxic and cytostatic therapies. Last but not least, it is a biomarker of

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