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Personalized versus evidence-based medicine with PET-based imaging

Abstract

In this Perspective the feasibility, scope and impact of integrating PET-based personalized medicine into the evidence-based clinical practice of oncology is discussed. The basic concepts of 'evidence-based medicine' and 'personalized medicine' at times seem contradictory; however, I will discuss, with specific clinical situations as examples, a synergistic and probably incremental link between the two and propose that the result of such integration will ultimately improve patient management. Tailoring therapeutic approaches and regimens by molecular imaging, with PET at its forefront, would enable disease management at the individual level and this modification would hopefully further strengthen the evidence-based approach in oncology.

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Figure 1: FDG-PET images detect response to chemotherapy.

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References

  1. Hutchings, M. & Barrington, S. F. PET/CT for therapy response assessment in lymphoma. J. Nucl. Med. 50 (Suppl. 1), 21S–30S (2009).

    Article  CAS  PubMed  Google Scholar 

  2. Basu, S. PET and PET/CT in gastrointestinal stromal tumours: the unanswered questions and the potential newer applications. Eur. J. Nucl. Med. Mol. Imaging 37, 1255–1258 (2010).

    Article  PubMed  Google Scholar 

  3. Torizuka, T. et al. Early therapy monitoring with FDG-PET in aggressive non-Hodgkin's lymphoma and Hodgkin's lymphoma. Eur. J. Nucl. Med. Mol. Imaging 31, 22–28 (2004).

    Article  PubMed  Google Scholar 

  4. Dührsen, U., Hüttmann, A., Jöckel, K. H. & Müller, S. Positron emission tomography guided therapy of aggressive non-Hodgkin lymphomas--the PETAL trial. Leuk. Lymphoma 50, 1757–1760 (2009).

    Article  PubMed  Google Scholar 

  5. Spaepen, K. et al. Early restaging positron emission tomography with 18F-fluorodeoxyglucose predicts outcome in patients with aggressive non-Hodgkin's lymphoma. Ann. Oncol. 13, 1356–1363 (2002).

    Article  CAS  PubMed  Google Scholar 

  6. Mikhaeel, N. G., Hutchings, M., Fields, P. A., O'Doherty, M. J. & Timothy, A. R. FDG-PET after two to three cycles of chemotherapy predicts progression-free and overall survival in high-grade non-Hodgkin lymphoma. Ann. Oncol. 16, 1514–1523 (2005).

    Article  CAS  PubMed  Google Scholar 

  7. Gallamini, A. et al. Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin's lymphoma: a report from a joint Italian–Danish study. J. Clin. Oncol. 25, 3746–3752 (2007).

    Article  CAS  PubMed  Google Scholar 

  8. Jerusalem, G. et al. Persistent tumor 18F-FDG uptake after a few cycles of polychemotherapy is predictive of treatment failure in non-Hodgkin's lymphoma. Haematologica 85, 613–618 (2000).

    CAS  PubMed  Google Scholar 

  9. Kostakoglu, L. et al. PET predicts prognosis after 1 cycle of chemotherapy in aggressive lymphoma and Hodgkin's disease. J. Nucl. Med. 43, 1018–1027 (2002).

    PubMed  Google Scholar 

  10. Mikhaeel, N. G., Timothy, A. R., O'Doherty, M. J., Hain, S. & Maisey, M. N. 18-FDG-PET as a prognostic indicator in the treatment of aggressive non-Hodgkin's lymphoma: comparison with CT. Leuk. Lymphoma 39, 543–553 (2000).

    Article  CAS  PubMed  Google Scholar 

  11. Juweid, M. E. et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J. Clin. Oncol. 25, 571–578 (2007).

    Article  PubMed  Google Scholar 

  12. Basu, S. & Alavi, A. Unparalleled contribution of 18F-FDG PET to medicine over 3 decades. J. Nucl. Med. 49, 17N–21N, 37N (2008).

    Article  PubMed  Google Scholar 

  13. Reed, C. E. et al. Results of the American College of Surgeons Oncology Group Z0050 Trial: the utility of positron emission tomography in staging potentially operable non-small cell lung cancer. J. Thorac. Cardiovasc. Surg. 126, 1943–1951 (2003).

    Article  PubMed  Google Scholar 

  14. Verhagen, A. F. T. et al. FDG-PET in staging lung cancer—how does it change the algorithm? Lung Cancer 44, 175–181 (2004).

    Article  CAS  PubMed  Google Scholar 

  15. Enzinger, P. C. & Mayer, R. J. Esophageal cancer. N. Engl. J. Med. 349, 2241–2252 (2003).

    Article  CAS  PubMed  Google Scholar 

  16. Quon, A. & Gambhir, S. S. FDG-PET and beyond: molecular breast cancer imaging. J. Clin. Oncol. 23, 1664–1673 (2005).

    Article  CAS  PubMed  Google Scholar 

  17. Burmeister, B. H. et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol. 6, 659–668 (2005).

    Article  PubMed  Google Scholar 

  18. Rouvelas, I. et al. Survival after surgery for oesophageal cancer: a population-based study. Lancet Oncol. 6, 864–870 (2005).

    Article  PubMed  Google Scholar 

  19. Basu, S. & Alavi, A. Should FDG-PET imaging be considered on a routine basis in clinical trials for carcinoma of esophagus to assure uniformity of protocols among sites? Eur. J. Nucl. Med. Mol. Imaging 34, 604–605 (2007).

    Article  PubMed  Google Scholar 

  20. Basu, S. & Alavi, A. Staging with PET and the “Will Rogers” effect: redefining prognosis and survival in patients with cancer. Eur. J. Nucl. Med. Mol. Imaging 35, 1–4 (2008).

    Article  PubMed  Google Scholar 

  21. Fletcher, J. W. et al. Recommendations on the use of 18F-FDG PET in oncology. J. Nucl. Med. 49, 480–508 (2008).

    Article  PubMed  Google Scholar 

  22. Weber, W. A. et al. Positron emission tomography in non-small-cell lung cancer: prediction of response to chemotherapy by quantitative assessment of glucose use. J. Clin. Oncol. 21, 2651–2657 (2003).

    Article  CAS  PubMed  Google Scholar 

  23. Brucher, B. L. D. M. et al. Neoadjuvant therapy of esophageal squamous cell carcinoma: response evaluation by positron emission tomography. Ann. Surg. 233, 300–309 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Bombardieri, E. The added value of metabolic imaging with FDG-PET in oesophageal cancer: prognostic role and prediction of response to treatment. Eur. J. Nucl. Med. Mol. Imaging 33, 753–758 (2006).

    Article  PubMed  Google Scholar 

  25. Basu, S., Mavi, A., Cermik, T., Houseni, M. & Alavi, A. Implications of standardized uptake value measurements of the primary lesions in proven cases of breast carcinoma with different degree of disease burden at diagnosis: does 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography predict tumor biology? Mol. Imaging Biol. 10, 62–66 (2008).

    Article  PubMed  Google Scholar 

  26. Winter, M. C. & Hancock, B. W. Ten years of rituximab in NHL. Expert Opin. Drug Saf. 8, 223–235 (2009).

    Article  CAS  PubMed  Google Scholar 

  27. Basu, S. & Alavi, A. Partial volume correction of standardized uptake values and the dual time point in FDG-PET imaging: should these be routinely employed in assessing patients with cancer? Eur. J. Nucl. Med. Mol. Imaging 34, 1527–1529 (2007).

    Article  PubMed  Google Scholar 

  28. Kumar, R. et al. Oncologic PET tracers beyond [(18)F]FDG and the novel quantitative approaches in PET imaging. Q. J. Nucl. Med. Mol. Imaging 52, 50–65 (2008).

    CAS  PubMed  Google Scholar 

  29. Basu, S., Kumar, R., Rubello, D., Fanti, S. & Alavi, A. PET imaging in neuroendocrine tumors: current status and future prospects. Minerva Endocrinol. 33, 257–275 (2008).

    CAS  PubMed  Google Scholar 

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Basu, S. Personalized versus evidence-based medicine with PET-based imaging. Nat Rev Clin Oncol 7, 665–668 (2010). https://doi.org/10.1038/nrclinonc.2010.121

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