¹⁸F-FDG PET/CT for response assessment in Hodgkin lymphoma undergoing immunotherapy with checkpoint inhibitors

Abstract

Our aim was to evaluate Hodgkin Lymphoma (HL) response to checkpoint inhibitors with F-FDG PET/CT. Forty three refractory or relapsed HL patients were investigated before immunotherapy, 8 weeks and 17 weeks after administration of either nivolumab or pembrolizumab. The median follow-up was 19 months. Best clinical response was complete response (CR) in 26 patients, partial response (PR) in 5 patients, stable disease (SD) in 8 patients, and progression disease (PD) in 4 patients. At the early assessment, Deauville Score (DS) resulted significantly different in responder group compared to nonresponders. SUVmax was significantly lower in responders, while there was no relevant modification in the tumor burden. At interim evaluation, DS well differentiated responder group. A significant decrease in glucose metabolism and tumor burden parameters was observed in responder patients, who presented with a longer progression-free survival then nonresponders.F-FDG PET/CT provides a reliable indication of treatment response under checkpoints inhibitors, even at an early assessment.

PET/CT imaging for tumour response assessment to immunotherapy: current status and future directions

“…1) with improved clinical outcome [57]. In the setting of early treatment response of HL and anti-PD-1treatment, both Lugano criteria and LYRIC performed equally with equivocal findings [58], a result that possibly relates to the rather rare occurrence of pseudoprogression in HL [55,56,59].…”

Immunotherapy by Immune Checkpoint Inhibitors and Nuclear Medicine Imaging: Current and Future Applications

“…However, concerning Hodgkin lymphoma, the contribution of LYRIC compared to the standard Lugano classification seems limited, because pseudoprogressions seem very rare in this disease. Thus, no pseudoprogression was reported in the two studies, including a total of 60 patients with refractory or relapsed Hodgkin lymphoma treated with immunotherapy and having an early therapeutic evaluation (2 to 3 months) by 18 F-FDG PET/CT [70,71]. Moreover, in a retrospective multicentric study including 45 patients with Hodgkin lymphoma treated by nivolumab, the classification at the 18 F-FDG PET performed at 2.0 months (interquartile range: 1.7-3.7 months) was identical between Lugano criteria and LYRIC, since all 16 progression events on this examination classified as an indeterminate response per LYRIC were confirmed as progressive diseases on subsequent evaluations [72].…”

Deauville score: the Phoenix rising from ashes

“…This limitation of the PET use with checkpoint inhibitors is clear when performing a PubMed research for: BPET^, or Bimmunother-apy^, or BHodgkin^, or Blymphoma^. Only three original articles appear pertinent to the argument for checkpoint inhibitors, all retrospective [9][10][11], with one moreover analyzing chemotherapy or chemo-anti-PD-1 combination after failed anti-PD-1 therapy [11]. Nevertheless, the common trait d'union for the manuscripts is the predictive potential of metabolic response assessment with Deauville score already after a few cycles of immunotherapy (Fig.…”

“…The papers quote the 5-point scale after 2-3 months of anti-PD-1 (either nivolumab or pembrolizumab) as predictive of subsequent response 4-6 months later [9,10]. Moreover, the classification of patients into responders (Complete Response + Partial Response) or non-responders (Stable Disease + Progressive Disease) to immunotherapy could correlate significantly with progressionfree survival of the cohort [10]. Yet, when the common models of response to therapy seem to fail in new immune-modulatory regimens, Deauville score, like the mythological Phoenix, rises from its ashes.…”