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Article

Circulating Tumor Cells and Metabolic Parameters in NSCLC Patients Treated with Checkpoint Inhibitors

1
Nuclear Medicine, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
2
Anatomy and Histopathology, Santa Chiara Hospital, 38122 Trento, Italy
3
Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
4
Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
5
Pathology, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(2), 487; https://doi.org/10.3390/cancers12020487
Received: 27 November 2019 / Revised: 4 February 2020 / Accepted: 17 February 2020 / Published: 19 February 2020
(This article belongs to the Special Issue Role of Medical Imaging in Cancers)
Circulating tumor cells (CTC) count and characterization have been associated with poor prognosis in recent studies. Our aim was to examine CTC count and its association with metabolic parameters and clinical outcomes in non-small cell lung carcinoma (NSCLC) patients treated with immune checkpoint inhibitors (ICI). For this prospective study, data from 35 patients (23 males, 12 females) were collected and analyzed. All patients underwent an 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) scan and CTC detection through Isolation by Size of Tumor/Trophoblastic Cells (ISET) from peripheral blood samples obtained at baseline and 8 weeks after ICI initiation. Association of CTC count with clinical and metabolic characteristics was studied. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan–Meier method and the log-rank test. Median follow-up was 13.2 months (range of 4.9–21.6). CTC were identified in 16 out of 35 patients (45.7%) at baseline and 10 out of 24 patients at 8 weeks (41.7%). Mean CTC numbers before and after 8 weeks were 15 ± 28 and 11 ± 19, respectively. Prior to ICI, the mean CTC number was significantly higher in treatment-naïve patients (34 ± 39 vs. 9 ± 21, p = 0.004). CTC count variation (ΔCTC) was significantly associated with tumor metabolic response set by European Organization for Research and Treatment of Cancer (EORTC) criteria (p = 0.033). At the first restaging, patients with a high tumor burden, that is, metabolic tumor volume (MTV) and total lesion glycolysis (TLG), had a higher CTC count (p = 0.009). The combination of mean CTC and median MTV at 8 weeks was associated with PFS (p < 0.001) and OS (p = 0.024). Multivariate analysis identified CTC count at 8 weeks as an independent predictor for PFS and OS, whereas ΔMTV and maximum standardized uptake value variation (ΔSUVmax) was predictive for PFS and OS, respectively. Our study confirmed that CTC number is modulated by previous treatments and correlates with metabolic response during ICI. Moreover, elevated CTC count, along with metabolic parameters, were found to be prognostic factors for PFS and OS. View Full-Text
Keywords: non-small-cell lung cancer; circulating tumor cells; PET/CT; immunotherapy; response to treatment non-small-cell lung cancer; circulating tumor cells; PET/CT; immunotherapy; response to treatment
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MDPI and ACS Style

Castello, A.; Carbone, F.G.; Rossi, S.; Monterisi, S.; Federico, D.; Toschi, L.; Lopci, E. Circulating Tumor Cells and Metabolic Parameters in NSCLC Patients Treated with Checkpoint Inhibitors. Cancers 2020, 12, 487. https://doi.org/10.3390/cancers12020487

AMA Style

Castello A, Carbone FG, Rossi S, Monterisi S, Federico D, Toschi L, Lopci E. Circulating Tumor Cells and Metabolic Parameters in NSCLC Patients Treated with Checkpoint Inhibitors. Cancers. 2020; 12(2):487. https://doi.org/10.3390/cancers12020487

Chicago/Turabian Style

Castello, Angelo; Carbone, Francesco G.; Rossi, Sabrina; Monterisi, Simona; Federico, Davide; Toschi, Luca; Lopci, Egesta. 2020. "Circulating Tumor Cells and Metabolic Parameters in NSCLC Patients Treated with Checkpoint Inhibitors" Cancers 12, no. 2: 487. https://doi.org/10.3390/cancers12020487

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