59 Low brain metabolism measured by routine imaging scans is linked to higher death rates in patients with advanced non-small cell lung cancer, new research has found. The study, published in the July issue of The Journal of Nuclear Medicine, shows that incorporating brain ¹⁸F-FDG uptake with other clinical, tumour, and biological data can improve predictions of how long patients are likely to live. This could help doctors identify those who might benefit most from early supportive care. Lung cancer remains one of the leading causes of cancer-related deaths worldwide. In 2022, there were an estimated 2.5 million new cases and 1.8 million deaths globally, according to the World Health Organization. In the UK, more than 50,000 people are diagnosed each year, with around 32,800 deaths recorded in recent figures. Despite advances in treatment, the outlook for many patients is still poor. Mean overall survival ranges from more than three years in early-stage disease to less than five months in the metastatic stage. Management of metastatic lung cancer continues to pose significant challenges, with some patients showing resistance to therapies or only temporary benefits. The research was led by Julie Auriac, PhD, a research engineer at the Imaging, Innovative Radiotherapy, and Systems Medicine Laboratory (IRIS) in Orsay, France. “Recent studies have suggested that metabolic activity and density in various organs and tissues measured from whole-body ¹⁸F-FDG PET/CT images provide valuable information for predicting patient outcomes in lung cancer by reflecting the patient’s general condition,” said Auriac. “The aim of this study was to evaluate the relationship between brain metabolic activity, measured using ¹⁸F-FDG PET/CT, and survival in patients with advanced NSCLC.” The retrospective study analysed patients with advanced non-small cell lung cancer who had pretreatment ¹⁸F-FDG PET/CT scans between 2010 and 2023. Researchers gathered clinical and biologic data, tumour features, and brain metabolism measurements, then assessed how well these factors predicted overall survival and examined links between brain metabolism and other biomarkers. Higher brain metabolism was associated with longer overall survival. Brain metabolism levels were significantly lower in patients who died within one year compared with those still alive at that point. Brain metabolism emerged as an independent prognostic factor and provided complementary information to existing clinical and blood biomarkers. “Our findings highlight the importance of considering cancer as a systemic disease,” said Auriac. “They suggest that the patient’s prognosis does not only depend on tumour features; other organs and tissues, which have so far remained largely unexplored, may also provide valuable information about the patient’s outcome.” Auriac continued, “Importantly, these metabolic measurements are available without requiring any additional examinations for the patient, as the brain metabolism can easily be obtained from ¹⁸F-FDG PET/CT images acquired during routine clinical care, representing a more efficient use of existing data.” The study authors include researchers from institutions such as Institut Curie and collaborators in Austria and Germany. In the UK, almost 45% of lung cancer patients survive one year or more after diagnosis, but only around 15% reach five years, with outcomes often more limited in advanced cases. Experts hope tools like brain metabolism assessment could help personalise care and direct resources, such as palliative support, more effectively, allowing clinicians to stratify patients using imaging they already perform, without extra tests or costs. Further validation in larger or prospective studies could strengthen integration into routine practice. As treatments for non-small cell lung cancer evolve with targeted therapies and immunotherapy, combining imaging biomarkers with traditional factors may refine decision-making and offer a practical way to enhance existing data for better-informed care in advanced lung cancer.