369 POOR CORRELATION BETWEEN FDG-PET AND PATHOLOGIC RESULTS AFTER EXPERIMENTAL NEOADJUVANT IMMUNOCHEMOTHERAPY FOR GASTROESOPHAGEAL ADENOCARCINOMA: RESULTS OF A CLINICAL TRIAL
Bibliographic record
Abstract
Abstract A lack of FDG-PET response to neoadjuvant chemotherapy for gastroesophageal adenocarcinoma is considered as indicative of a poor prognosis, whereas pathologic complete or near-complete response (pCR/near-pCR) predicts a more favorable outcome. In a single-arm phase II trial of perioperative immunochemotherapy, we sought to establish a correlation between the results of an FDG-PET performed after the neoadjuvant part of the treatment and the pathologic results obtained after surgery. Methods Inclusion criteria: locally advanced gastroesophageal adenocarcinoma (T3 and/or N+); adequate organ function; ECOG PS 0–1; no contraindication to immunotherapy; Staging: CT, FDG-PET, EUS, diagnostic laparoscopy. Eligible patients receive docetaxel/cisplatin/5-FU (mDCF) on day 1 and avelumab on day 4 of each 2-week cycle and are restaged after 4 cycles. FDG-PET response is defined as reduction of >35% of pre-treatment SUV. Surgery is performed if no disease progression. Four cycles of mDCF/avelumab are administered after surgery. Tumor regression is scored from 0 (no tumor cells) to 3 (no tumor regression). The primary endpoint is the pCR/near-PCR rate (score 0–1). Results As of February 24, 2020, 28 patients have been enrolled and 22 have been operated. Paired FDG-PET response and pathologic response data are available for 21 patients. We observed 16/21 FDG-PET responses and 6/21 pCR/near-pCR. Of the latter, 4 were associated with an FDG-PET response and 2 with no FDG-PET response. Ten patients with score 3 tumor regression had had FDG-PET response. No statistical correlation could be found between FDG-PET response and likelihood of pCR/near-pCR. Conclusion Given the discrepancy observed between FDG-PET and pathologic results, the need for a repeat FDG-PET for gastroesophageal adenocarcinoma after neoadjuvant immunochemotherapy and before surgery should be questioned. Analysis of the tumor microenvironment could possibly explain these results. Future studies will look into correlation between the results presented and survival.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".