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

Abstract

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.

CD69 and SBK1 as potential predictors of responses to PD-1/PD-L1 blockade cancer immunotherapy in lung cancer and melanoma

“…Although PD-1/PD-L1 blockade exhibits remarkable anticancer efficacy and safety, it is estimated that it benefits less than half of applicable cancer patients ( 8 – 10 ). To better predict response to PD-1/PD-L1 blockade and avoid the waste of medical resources, robust biomarkers have been developed using various strategies, including imaging omics ( 27 , 28 ) and patient derived biological materials ( 29 – 31 ). Furthermore, genomic based biomarkers, like Tumor Mutational Burden ( 32 ), Antigen Processing Machinery score ( 33 ), Tumor Immune Dysfunction and Exclusion score ( 34 ) and Gene Expression Profiles score ( 35 ) are reported as prediction biomarkers.…”

Metabolic Tumor Volume as Significant Predictor for Chemotherapy Containing PD-L1 Blocker in Extensive Stage Small Cell Lung Cancer

“…SUV max , MTV, and TLG (= SUV mean × MTV) were calculated semi-automatically for each tumor using the SUV mean value obtained from the liver VOI plus 1.5 SD as the threshold value. Active sites other than tumors, such as the myocardium, gastrointestinal tract, kidney, and urinary tract, were manually excluded from the direction of a certi ed nuclear medicine physician [11,15,18].…”

“…Nowadays, 2-Deoxy-2-[ uorine-18]-uoro-d-glucose ( 18 F-FDG) positron emission tomography (PET) imaging is widely used as a convenient modality to distinguish benign from malignant lesions. Recently, several researchers have reported that metabolic tumor activity on 18 F-FDG uptake can predict the outcome of ICIs treatment in patients with advanced NSCLC [6][7][8][9][10][11]. As indicators of glucose metabolism within tumor cells, maximum standardized uptake values (SUV max ), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on 18 F-FDG accumulation have been investigated to determine the potential of a signi cant predictor; however, the metabolic activity of MTV or TLG may be appropriate for therapeutic monitoring or outcome after immunotherapy administration based on previous clinical evidence [6][7][8][9][10][11][12][13][14][15].…”

“…Recently, several researchers have reported that metabolic tumor activity on 18 F-FDG uptake can predict the outcome of ICIs treatment in patients with advanced NSCLC [6][7][8][9][10][11]. As indicators of glucose metabolism within tumor cells, maximum standardized uptake values (SUV max ), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on 18 F-FDG accumulation have been investigated to determine the potential of a signi cant predictor; however, the metabolic activity of MTV or TLG may be appropriate for therapeutic monitoring or outcome after immunotherapy administration based on previous clinical evidence [6][7][8][9][10][11][12][13][14][15]. Several reports have described the relationship between SUV max by 18 F-FDG uptake and the tumor immune microenvironment including PD-L1 or tumor in ltrating lymphocytes (TILs) in patients with lung cancer [7,8,16].…”

Clinical significance of visual cardiac 18F-FDG uptake in advanced non-small cell lung cancer

“…In this study, a ve-point scale (5-PS) based on 18 F-FDG uptake was used for therapeutic monitoring of patients with malignant lymphoma and NSCLC [12,13]. The 5-PS score was de ned as follows:…”