Response evaluation and survival prediction following PD-1 immunotherapy in patients with non-small-cell lung cancer: comparison of assessment methods.

Ayati, Narjess; Lee, Sze Ting; Zakavi, Seyed Rasoul; Cheng, Melissa; Lau, Eddie; Parakh, Sagun; Pathmaraj, Kunthi; Scott, Andrew M.

doi:10.2967/jnumed.120.254508

Cited by 20 publications

(57 citation statements)

References 23 publications

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“…Actually, not. Some reports have attempted to compare various methods, particularly in melanoma and NSCLC patients [ 14 , 38 , 39 , 40 , 41 , 42 , 43 ], proving the superiority of some of the utilized criteria over others ( Table 2 ). Ultimately, all available response criteria, metabolic or morphological, retain the capability to predict response and outcome.…”

Section: Response Assessment In Solid Tumors Treated With Checkpoint Inhibitorsmentioning

confidence: 99%

Immunotherapy Monitoring with Immune Checkpoint Inhibitors Based on [18F]FDG PET/CT in Metastatic Melanomas and Lung Cancer

Lopci

2021

JCM

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Immunotherapy with checkpoint inhibitors has prompted a major change not only in cancer treatment but also in medical imaging. In parallel with the implementation of new drugs modulating the immune system, new response criteria have been developed, aiming to overcome clinical drawbacks related to the new, unusual, patterns of response characterizing both solid tumors and lymphoma during the course of immunotherapy. The acknowledgement of pseudo-progression, hyper-progression, immune-dissociated response and so forth, has become mandatory for all imagers dealing with this clinical scenario. A long list of acronyms, i.e., irRC, iRECIST, irRECIST, imRECIST, PECRIT, PERCIMT, imPERCIST, iPERCIST, depicts the enormous effort made by radiology and nuclear medicine physicians in the last decade to optimize imaging parameters for better prediction of clinical benefit in immunotherapy regimens. Quite frequently, a combination of clinical-laboratory data with imaging findings has been tested, proving the ability to stratify patients into various risk groups. The next steps necessarily require a large scale validation of the most robust criteria, as well as the clinical implementation of immune-targeting tracers for immuno-PET or the exploitation of radiomics and artificial intelligence as complementary tools during the course of immunotherapy administration. For the present review article, a summary of PET/CT role for immunotherapy monitoring will be provided. By scrolling into various cancer types and applied response criteria, the reader will obtain necessary information for better understanding the potentials and limitations of the modality in the clinical setting.

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Section: Response Assessment In Solid Tumors Treated With Checkpoint Inhibitorsmentioning

confidence: 99%

Immunotherapy Monitoring with Immune Checkpoint Inhibitors Based on [18F]FDG PET/CT in Metastatic Melanomas and Lung Cancer

Lopci

2021

JCM

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“…In addition, response assessment on CT and 18 F-FDG PET was performed according to morphological criteria such as the RECIST and metabolic criteria such as the immunotherapy-modified PET Response Criteria in Solid Tumors (imPERCIST). 15 The authors concluded that 18 F-FDG PET according to the imPERCIST criteria after 3 or 4 cycles of ICIs correctly identified therapeutic response and predicted survival compared with CT according to the RECIST. The level of 18 F-FDG accumulation within tumor cells was able to discriminate between patients with longer and shorter survival.…”

Section: Discussionmentioning

confidence: 99%

Visual Assessment of 18F-FDG Uptake on PET to Predict Survival Benefit to PD-1 Blockade in Non–Small Cell Lung Cancer

Hashimoto¹,

Kaira²,

Yamaguchi³

et al. 2022

Clin Nucl Med

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Background: Programmed death 1 (PD-1) blockade is a standard treatment for patients with metastatic non-small cell lung cancer (NSCLC). Approximately 20% patients receiving PD-1 blockade monotherapy can survive for more than 5 years. However, there are limited data on the optimal biomarkers for predicting long-term outcomes. Therefore, this study aimed to evaluate the prognostic significance of 18 F-FDG uptake in patients with NSCLC responding to PD-1 blockade. Patients and Methods: Thirty-eight patients with advanced NSCLC who underwent 18 F-FDG PET after confirmation of clinical response to PD-1 blockade monotherapy were retrospectively included in this study. Visual assessment using a 5-point scale score according to 18 F-FDG uptake was performed, and the 18 F-FDG uptake cutoff score for prolonged response to PD-1 blockade was defined as 3 (low score: 1, 2, or 3 and high score: 4 or 5). Results: A significantly greater number of patients with low scores had a performance status of 0 or 1 than patients with high scores. Among the 38 patients, 20 (53%) had a low score and 18 (47%) had a high score. Progression-free survival and overall survival were significantly longer in patients with low scores than in patients with high scores. Low 18 F-FDG uptake was an independent prognostic factor for predicting favorable progression-free survival and overall survival, as confirmed by multivariate analysis. Conclusions: Tumors with lower 18 F-FDG uptake on PET than normal hepatic lesions exhibit the possibility of prolonged response to PD-1 blockade. Visual assessment on PET is easy for every clinician and is understandable to confirm aggressive tumor activity.

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“… 28 As dual-time-point evaluation scale, imPERCIST introduces a need to confirm a PD such as the updated radiological criteria, but such a control may limit the risk of a false-positive PET scan. 29 The DR case presented in Figure 1 was classified as metabolic PD by PERCIST because of the appearance of a new metabolic lesion in the proximal right humerus but a partial metabolic response by imPERCIST. Thus, DR should not simply be included in the category of progressive, stable, or responsive disease.…”

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

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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.

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Response evaluation and survival prediction following PD-1 immunotherapy in patients with non-small-cell lung cancer: comparison of assessment methods.

Cited by 20 publications

References 23 publications

Immunotherapy Monitoring with Immune Checkpoint Inhibitors Based on [18F]FDG PET/CT in Metastatic Melanomas and Lung Cancer

Immunotherapy Monitoring with Immune Checkpoint Inhibitors Based on [18F]FDG PET/CT in Metastatic Melanomas and Lung Cancer

Visual Assessment of 18F-FDG Uptake on PET to Predict Survival Benefit to PD-1 Blockade in Non–Small Cell Lung Cancer

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

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