The value of 18F-FDG PET/CT for predicting or monitoring immunotherapy response in patients with metastatic melanoma: a systematic review and meta-analysis

Ayati, Narjess; Sadeghi, Ramin; Kiamanesh, Zahra; Lee, Sze Ting; Zakavi, Seyed Rasoul; Scott, Andrew M.

doi:10.1007/s00259-020-04967-9

Cited by 66 publications

(55 citation statements)

References 45 publications

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“…Instead, PERCIMT suggest the application of a threshold of four newly emerged lesions—with a decreasing cutoff of lesion number as the functional diameter of the lesions increases—for patient classification to progressive disease (Table 1 ) [ 37 ]. The hitherto preliminary application of PERCIMT has shown promising results in patient stratification [ 21 , 38 – 41 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of early metabolic progression in melanoma patients under immunotherapy: an 18F-FDG PET/CT study

et al. 2021

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Background The usage of immune checkpoint inhibitors (ICIs) is the standard practice for the treatment of metastatic melanoma. However, a significant amount of patients show no response to immunotherapy, while issues on its reliable response interpretation exist. Aim of this study was to investigate the phenomenon of early disease progression in 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in melanoma patients treated with ICIs. Methods Thirty-one patients under ICIs serially monitored with 18F-FDG PET/CT were enrolled. All patients exhibited progressive metabolic disease (PMD) after two ICIs’ cycles according to the European Organization for Research and Treatment of Cancer (EORTC) criteria, and were characterized as unconfirmed PMD (uPMD). They were further followed with at least one PET/CT for either confirmation of PMD (cPMD) or demonstration of pseudoprogression remission. Patients were also evaluated with the PET Response Evaluation Criteria for Immunotherapy (PERCIMT). Moreover, in an attempt to investigate immune activation, the spleen to liver ratios (SLRmean, SLRmax) of 18F-FDG uptake were measured. Results Median follow up was 69.7 months [64.6–NA]. According to EORTC, 26/31 patients with uPMD eventually showed cPMD (83.9%) and 5/31 patients showed pseudoprogression (16.1%). Patients with cPMD (n = 26) had a median OS of 10.9 months [8.5–NA], while those with pseudoprogression (n = 5) did not reach a median OS [40.9–NA]. Respectively, after application of PERCIMT, 2/5 patients of the pseudoprogression group were correctly classified as non-PMD, reducing the uPMD cohort to 29 patients; eventually, 26/29 patients demonstrated cPMD (89.7%) and 3/29 pseudoprogression (10.3%). One further patient with pseudoprogression exhibited transient, sarcoid-like, mediastinal/hilar lymphadenopathy, a known immune-related adverse event (irAE). Finally, patients eventually showing cPMD exhibited a significantly higher SLRmean than those showing pseudoprogression after two ICIs’ cycles (p = 0.038). Conclusion PET/CT, performed already after administration of two ICIs’ cycles, can identify the majority of non-responders in melanoma immunotherapy. In order to tackle however, the non-negligible phenomenon of pseudoprogression, another follow-up PET/CT, the usage of novel response criteria and vigilance over emergence of radiological irAEs are recommended. Moreover, the investigation of spleen glucose metabolism may offer further prognostic information in melanoma patients under ICIs.

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Section: Discussionmentioning

confidence: 99%

Assessment of early metabolic progression in melanoma patients under immunotherapy: an 18F-FDG PET/CT study

et al. 2021

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“…As an advanced imaging examination, [ 18 F]F-FDG PET/CT (18F-fluorodeoxyglucose positron emission tomography/ computed tomography) is widely used for response monitoring and prognostication for locally advanced NSCLC (22)(23)(24). The study found that SUVpeak, MTV, and TLG has predictive significance in the response to immunotherapy in patients with melanoma (25).Another study showed that baseline MTVwb and SUVmean correlate with survival in advanced non-small cell lung cancer patients treated with pembrolizumab (26). At the same time, the entire tumor burden evaluated by 18F-FDG PET/ CT was proved to be the Predictors to immunotherapy in patients with metastatic lung cancer (27).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of SUVmax Combined With Lactate Dehydrogenase in Advanced Lung Cancer Patients Treated With Immune Checkpoint Inhibitor Plus Chemotherapy: A Retrospective Study

Wang

et al. 2021

Front. Oncol.

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PurposeThis research aims to investigate the predictive capacity of PET/CT quantitative parameters combined with haematological parameters in advanced lung cancer patients treated with immune checkpoint inhibitor (ICI) plus chemotherapy.MethodsA total of 120 patients who underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) were enrolled before therapy. The following parameters were calculated: the maximum, mean, and peak standardized uptake value (SUVmax, SUVmean, and SUVpeak, respectively); total tumour volume (MTV) and total lesion glycolysis (TLG); and whole-body metabolic values (MTVwb, TLGwb, SUVmeanwb, and SUVmaxwb). Lactate dehydrogenase (LDH) levels, absolute neutrophil count, absolute platelet count, albumin levels and derived neutrophil to lymphocyte ratio (dNLR) were also computed. The associations between the variables and therapy outcome (evaluated by iRECIST) were analyzed.ResultsBased on iRECIST, 32 of 120 patients showed iPD, 43 iSD, 36 iPR and 9 iCR. Multivariate analysis found that SUVmax, MTVwb, LDH and absolute platelet count were associated with treatment response (P =0.015, P =0.005, P <0.001 and P =0.015, respectively). Kaplan-Meier survival analyses showed that SUVmax ≥11.42 and LDH ≥245 U/L were associated with shorter OS (P = 0.001 and P = 0.004, respectively). Multivariate Cox regression revealed that SUVmax and LDH alone were not correlated with survival prognosis (p>0.05), but the combination of SUVmax and LDH was independently associated with OS (P=0.015, P=0.001, respectively). The median survival time (MST) for the low (LDH<245 and SUVmax<11.42), intermediate(LDH<245 or SUVmax<11.42), and high(SUVmax≥11.42 and LDH≥245) groups was 24.10 months (95% CI: 19.43 to 28.77), 17.41 months (95% CI: 15.83 to 18.99), and 13.76 months (95% CI: 12.51 to 15.02), respectively.ConclusionThis study identified that SUVmax plus LDH correlated with the survival outcome in patients with advanced lung cancer receiving PD-1/PD-L1 blockade plus chemotherapy.

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“…In clinical routine, [ 18 F]FDG PET/CT has reached a pivotal role in the evaluation of response to immunotherapy, although it is far from a specific immuno-PET radiotracer. [ 18 F]FDG allows to visualize rapidly proliferating glucose-avid cancer cells (Warburg effect) and monitor immunotherapy response in different cancer types, such as melanoma, non-small-cell lung cancer, head & neck cancer, urothelial cancer and renal cell cancer [130][131][132][133]. However, during ICIs therapy, the presence of TILs and the inflammatory response may also lead to a transient increase in tumor volume and increased [ 18 F]FDG uptake in responding tumoral tissue.…”

Section: [18f]fdg Pet/ctmentioning

confidence: 99%

Molecular Imaging in Immunotherapy: A Systematic Review

Liberini¹,

Laudicella²,

Capozza³

et al. 2021

Preprint

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Immunotherapy is an effective therapeutic option for several cancers. In the last years, the introduction of checkpoint inhibitors (ICIs) has shifted the therapeutic landscape in oncology and improved patient prognosis in a variety of neoplastic diseases. However, to date, the selection of the best patients eligible for these therapies, as well as the response assessment is still challenging. Patients are mainly stratified using immunohistochemical analysis of the expression of anti-gens on biopsy specimens, such as PD-L1 and PD-1, on tumor cells, on peritumoral immune cells, and/or in the tumor microenvironment (TME). Recently, the use and development of imaging biomarkers able to assess in-vivo cancer-related processes are becoming more important. Today, positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is used routinely to evaluate tumor metabolism, and also to predict and monitor response to immunotherapy. Although highly sensitive, FDG-PET, in general, is rather unspecific. Novel radiopharmaceuticals (immuno-PET radiotracers) able to identify specific immune system targets are under investigation in pre-clinical and clinical settings. In this review, we will provide an overview of the main new immuno-PET radiotracers in development. We will also review the main players (immune cells, tumor cells, and molecular targets) involved in immunotherapy. Furthermore, we report current applications and the evidence of using [18F]FDG PET in immunotherapy, including the use of artificial intelligence (AI).

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The value of 18F-FDG PET/CT for predicting or monitoring immunotherapy response in patients with metastatic melanoma: a systematic review and meta-analysis

Cited by 66 publications

References 45 publications

Assessment of early metabolic progression in melanoma patients under immunotherapy: an 18F-FDG PET/CT study

Assessment of early metabolic progression in melanoma patients under immunotherapy: an 18F-FDG PET/CT study

Prognostic Significance of SUVmax Combined With Lactate Dehydrogenase in Advanced Lung Cancer Patients Treated With Immune Checkpoint Inhibitor Plus Chemotherapy: A Retrospective Study

Molecular Imaging in Immunotherapy: A Systematic Review

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