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

Abstract

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.

The Use of 18F-FDG PET/CT Metabolic Parameters in Predicting Overall Survival in Patients Undergoing Restaging for Malignant Melanoma

“…These specific parameters were not commonly reviewed in our patient cohort. Prognostication using 18 F-FDG PET/CT was also reviewed by Schweigoffer-Zwink et al, who demonstrated that metabolic parameters in patients with advanced cutaneous melanoma were predictive for survival in melanoma patients undergoing immunotherapy [23]. This study also found that tumor-to-background values had a stronger predictive value than MTV and TLG.…”

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

“…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.…”

Skin Cancer Pathobiology at a Glance: A Focus on Imaging Techniques and Their Potential for Improved Diagnosis and Surveillance in Clinical Cohorts

“…Within the last decade, molecular imaging techniques such as single photon emission computed tomography (SPECT/CT) and positron emission tomography (PET) have been extensively investigated to provide additional diagnostic information and help identify specific disease mechanisms in tumors, which consolidated their position in the diagnostic strategy of human cutaneous tumors [ 349 ]. The signaling pathways and molecular targets that may be harnessed for molecular imaging in cancer are glucose metabolism [ 255 ], integrin α v β 3 [ 271 ], melanocortin-1 receptor [ 332 ], PD-1/PD-L1 axis [ 272 ], and hence several other biochemical and molecular markers related to immune response and angiogenesis reside in the area of preclinical development [ 360 ]. Although both imaging modalities may be used to assess all skin cancer subtypes, anatomical imaging may be more relevant to NMSC.…”

“…Besides its usefulness in CM staging and prognosis, FDG PET has largely been used for evaluating the therapeutic responses in patients receiving systemic therapy, especially ICIs [ 255 , 256 ]. One study conducted by Ito et al reported that whole-body MTV obtained from baseline PET/CT scans might be a valuable prognostic biomarker among other clinical prognostic factors in melanoma patients treated with ipilimumab [ 257 ].…”