Early Reassessment of Total Metabolic Tumor Volume on FDG-PET/CT in Advanced Melanoma Patients Treated with Pembrolizumab Predicts Long-Term Outcome

Vermeulen, Sim; Awada, Gil; Keyaerts, Marleen; Neyns, Bart; Everaert, Hendrik

doi:10.3390/curroncol28030152

Cited by 6 publications

(5 citation statements)

References 20 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the anti-PD1 group, PET parameters, such as EORTC, delta MTV and delta TLG, correlated with patients' outcomes at one year in most of the patients with PD according to these PET metrics. In 36 patients evaluated between 2 to 4 months after treatment by pembrolizumab monotherapy, Vermeulen et al found that PFS and OS were significantly longer in patients achieving a decreased/stable TMTV compared with those with increasing TMTV [23]. In our study, we found a similar result for PFS but not for OS, probably due to the limited size of our series of patients.…”

Section: Discussionsupporting

confidence: 61%

“…The analysis of tumor metabolic volume has been evidenced as a relevant tool in the evaluation of metastatic melanoma treated by ICI, allowing not only baseline outcome prognostication [18,26] but also accurate prediction of the response to treatment [20,22,23]. In a study on 85 melanoma patients treated with ICI, the metabolic tumor volume at first evaluation proved to be an independent prognostic factor for OS, along with the presence of central nervous system lesions [20].…”

Section: Discussionmentioning

confidence: 99%

“…However, their clinical utility remains controversial, and to the best of our knowledge, only one study applied the imPERCIST5 criteria to a series of patients treated with ipilimumab, and none in patients on first-line antiPD1 (or anti PD1/anti CTLA4 combination) for advanced/metastatic melanoma [16]. Moreover, FDG PET-derived metabolic volume seems to be a highly promising approach as a prognostic factor on baseline FDG PET, as well as in the follow-up FDG PET examinations [19][20][21][22][23][24]. We investigated whether these two PET/CT criteria (PERCIST5 and imPERCIST5) had prognostic value in patients receiving first-line ICI for advanced or metastatic melanoma.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

18FDG PET Assessment of Therapeutic Response in Patients with Advanced or Metastatic Melanoma Treated with First-Line Immune Checkpoint Inhibitors

Rivas

Delyon

Martineau

et al. 2022

Cancers

View full text Add to dashboard Cite

Background: Immune checkpoint inhibitors (ICI) are currently the first-line treatment for patients with metastatic melanoma. We investigated the value of positron emission tomography (PET) response criteria to assess the therapeutic response to first-line ICI in this clinical context and explore the potential contribution of total tumor metabolic volume (TMTV) analysis. Methods: We conducted a retrospective study in patients treated with first-line ICI for advanced or metastatic melanoma, with 18F-FDG PET/CT performed at baseline and 3 months after starting treatment. Patients’ metabolic response was classified according to PERCIST5 and imPERCIST 5 criteria. TMTV was recorded for each examination. Results: Twenty-nine patients were included. The median overall survival (OS) was 51.2 months (IQR 13.6—not reached), and the OS rate at 2 years was 58.6%. Patients classified as responders (complete and partial response) had a 90.9% 2-year OS rate versus 38.9% for non-responders (stable disease and progressive disease) (p = 0.03), for PERCIST5 and imPERCIST 5 criteria. The median change in metabolic volume was 9.8% (IQR −59–+140%). No significant correlation between OS and changes in TMTV was found. Conclusion: The evaluation of response to immunotherapy using metabolic imaging with PERCIST5 and imPERCIST5 was significantly associated with OS in patients with advanced or metastatic melanoma.

show abstract

Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

18FDG PET Assessment of Therapeutic Response in Patients with Advanced or Metastatic Melanoma Treated with First-Line Immune Checkpoint Inhibitors

Rivas

Delyon

Martineau

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“…Employing the values of parameters in follow-up studies, Vermeulen et al reported an increase in total MTV on 2-to 4-month follow-up 2-[ 18 F]FDG PET/CT predicts worse OS and PFS [40]. There was a similar trend, although non-significant, for values on 5-to 6-month follow-up study [40]. Similarly, Nakamoto et al demonstrated that patients with higher MTV (≥23.44 cm 3 ) on the 3-month follow-up study have lower OS [41].…”

Section: Tablementioning

confidence: 99%

Prognostic value of 2-[18F]FDG PET-CT in metastatic melanoma patients receiving immunotherapy

Schweighofer-Zwink

Manafi‐Farid

Kölblinger

et al. 2022

European Journal of Radiology

View full text Add to dashboard Cite

The 2-fluorodeoxyglucose positron emission tomography/computed tomography (2-[ 18 F]FDG PET/CT) is used for the evaluation of response to immunotherapy in malignant melanoma. Here, we evaluated the prognostic value of various metabolic parameters in baseline and different time points after therapy. Methods: In this retrospective study, 51 metastatic melanoma patients, who had received immunotherapy, were included. Patients with baseline and two follow-up 2-[ 18 F]FDG PET/CT studies (3 and 6 months after therapy) were selected. Multiple metabolic parameters and tumor-to-background ratios (TBRs) were extracted and correlated with OS. Results: The 3-and 5-year OS rates were 49% and 43.1%, respectively. On baseline 2-[ 18 F]FDG PET/CT, only standardized uptake value corrected for lean body mass (SUL max and SUL peak ), as well as most of the TBRs were predictive for 3-and 5-year OS rates. Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and most of the TBRs were predictive on both follow-up studies. Also, the changes in values of MTV, TLG and most of the TBRs from the baseline to the 3-month and 6-month follow-up studies were prognostic. On multivariate analysis, all of the most predictive parameters for OS were derived from the 3-month follow-up study. The ratio of TBR mean to the mediastinum was the best factor (cutoff value of 2.15, sensitivity of 88.5% and specificity of 68.0% for 3year survival). Conclusion: Metabolic parameters derived from 2-[ 18 F]FDG PET/CT are valuable tools for the prediction of 3-and 5-year OS rates in metastatic melanoma patients undergoing immunotherapy. The 3-month follow-up 2-[ 18 F] FDG PET/CT is of particular importance in this regard.

show abstract

“… 6 Early total metabolic tumor volume evolution on 18 FDG-PET/CT, an interesting canulated parameter that can be easily (semi)-automatically determined, was found to be associated with long-term outcome in advanced melanoma patients with pembrolizumab treatment. 30 Evaluation by PET, however, has some limitations. First, the specificity can be low for a multifunctional radiotracer 18 FDG whose uptakes concern tumor and some inflammatory cells.…”

Section: Definition Of Immune-related Dr By Radiological Evaluation C...mentioning

confidence: 99%

Immune-related dissociated response as a specific atypical response pattern in solid tumors with immune checkpoint blockade

et al. 2022

View full text Add to dashboard Cite

Immune checkpoint blockade using immune checkpoint inhibitors, including cytotoxic T-lymphocyte-associated antigen–4 and programmed cell death protein-1/programmed cell death ligand–1 inhibitors, has revolutionized systematic treatment for advanced solid tumors, with unprecedented survival benefit and tolerable toxicity. Nivolumab, pembrolizumab, cemiplimab, avelumab, durvalumab, atezolizumab, and ipilimumab are currently approved standard treatment options for various human cancer types. The response rate to immune checkpoint inhibitors, however, is unsatisfactory, and unexpectedly, atypical radiological responses, including delayed responses, pseudoprogression, hyperprogression, and dissociated responses (DRs), are observed in a small subgroup of patients. The benefit of immunotherapy for advanced patients who exhibit atypical responses is underestimated according to the conventional response evaluation criteria in solid tumors (RECIST). In particular, DR is considered a mixed radiological or heterogeneous response pattern when responding and nonresponding lesions or new lesions coexist simultaneously. The rate of DR reported in different studies encompass a wide range of 3.3–47.8% based on diverse definition of DR. Although DR is also associated with treatment efficacy and a favorable prognosis, it is different from pseudoprogression, which has concordant progressive lesions and can be regularly captured by immune RECIST. This review article aims to comprehensively determine the frequency, definition, radiological evaluation, probable molecular mechanisms, prognosis, and clinical management of immune-related DR and help clinicians and radiologists objectively and correctly interpret this specific atypical response and better understand and manage cancer patients with immunotherapy and guarantee their best clinical benefit.

show abstract

Early Reassessment of Total Metabolic Tumor Volume on FDG-PET/CT in Advanced Melanoma Patients Treated with Pembrolizumab Predicts Long-Term Outcome

Cited by 6 publications

References 20 publications

18FDG PET Assessment of Therapeutic Response in Patients with Advanced or Metastatic Melanoma Treated with First-Line Immune Checkpoint Inhibitors

18FDG PET Assessment of Therapeutic Response in Patients with Advanced or Metastatic Melanoma Treated with First-Line Immune Checkpoint Inhibitors

Prognostic value of 2-[18F]FDG PET-CT in metastatic melanoma patients receiving immunotherapy

Immune-related dissociated response as a specific atypical response pattern in solid tumors with immune checkpoint blockade

Contact Info

Product

Resources

About