Romain-David Seban1, Laura Mezquita2, Arnaud Berenbaum1, Laurent Dercle3, Angela Botticella4, Cécile Le Pechoux4, Caroline Caramella5, Eric Deutsch4,6,7, Serena Grimaldi1, Julien Adam8, Samy Ammari5, David Planchard2, Sophie Leboulleux1, Benjamin Besse9,10. 1. Gustave Roussy, Department of Nuclear Medicine and Endocrine Oncology, Université Paris-Saclay, Villejuif, France. 2. Gustave Roussy, Department of Medical Oncology, Thoracic Unit, Villejuif, France. 3. Gustave Roussy Cancer Campus, UMR1015, Université Paris Saclay, Villejuif, France. 4. Gustave Roussy, Department of Radiation Oncology, Villejuif, France. 5. Gustave Roussy, Department of Radiology, Université Paris-Saclay, Villejuif, France. 6. Gustave Roussy Cancer Campus INSERM U1030Radiomics team, 94800, Villejuif, France. 7. Gustave Roussy Drug Development Department (DITEP), Villejuif, France. 8. Gustave Roussy, Department of Pathology, Université Paris-Saclay, Villejuif, France. 9. Gustave Roussy, Department of Medical Oncology, Thoracic Unit, Villejuif, France. Benjamin.BESSE@gustaveroussy.fr. 10. Gustave Roussy Drug Development Department (DITEP), Villejuif, France. Benjamin.BESSE@gustaveroussy.fr.
Abstract
PURPOSE: We aimed to evaluate if imaging biomarkers on FDG PET are associated with clinical outcomes in patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). METHODS: In this retrospective monocentric study, we included 109 patients with advanced NSCLC who underwent baseline FDG PET/CT before ICI initiation between July 2013 and September 2018. Clinical, biological (including dNLR = neutrophils/[leukocytes minus neutrophils]), pathological and PET parameters (tumor SUVmax, total metabolic tumor volume [TMTV]) were evaluated. A multivariate prediction model was developed using Cox models for progression-free survival (PFS) and overall survival (OS). The association between biomarkers on FDG PET/CT and disease clinical benefit (DCB) was tested using logistic regression. RESULTS: Eighty patients were eligible. Median follow-up was 11.6 months (95%CI 7.7-15.5). Sixty-four and 52 patients experienced progression and death, respectively. DCB was 40%. In multivariate analyses, TMTV > 75 cm3 and dNLR > 3 were associated with shorter OS (HR 2.5, 95%CI 1.3-4.7 and HR 3.3, 95%CI 1.6-6.4) and absence of DCB (OR 0.3, 95%CI 0.1-0.9 and OR 0.4, 95%CI 0.2-0.9). Unlike TMTV, dNLR was a significant prognostic factor for PFS (HR 1.9, 95%CI 1.1-3.3) along with anemia (HR 1.9, 95%CI 1.2-3.8). No association was observed between tumor SUVmax and PFS or OS. CONCLUSION: Baseline tumor burden (TMTV) on FDG PET/CT scans and inflammatory status (dNLR) were associated with poor OS and absence of DCB for ICI treatment in advanced NSCLC patients, unlike tumor SUVmax, and may be used together to improve the selection of appropriate candidates.
PURPOSE: We aimed to evaluate if imaging biomarkers on FDG PET are associated with clinical outcomes in patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). METHODS: In this retrospective monocentric study, we included 109 patients with advanced NSCLC who underwent baseline FDG PET/CT before ICI initiation between July 2013 and September 2018. Clinical, biological (including dNLR = neutrophils/[leukocytes minus neutrophils]), pathological and PET parameters (tumor SUVmax, total metabolic tumor volume [TMTV]) were evaluated. A multivariate prediction model was developed using Cox models for progression-free survival (PFS) and overall survival (OS). The association between biomarkers on FDG PET/CT and disease clinical benefit (DCB) was tested using logistic regression. RESULTS: Eighty patients were eligible. Median follow-up was 11.6 months (95%CI 7.7-15.5). Sixty-four and 52 patients experienced progression and death, respectively. DCB was 40%. In multivariate analyses, TMTV > 75 cm3 and dNLR > 3 were associated with shorter OS (HR 2.5, 95%CI 1.3-4.7 and HR 3.3, 95%CI 1.6-6.4) and absence of DCB (OR 0.3, 95%CI 0.1-0.9 and OR 0.4, 95%CI 0.2-0.9). Unlike TMTV, dNLR was a significant prognostic factor for PFS (HR 1.9, 95%CI 1.1-3.3) along with anemia (HR 1.9, 95%CI 1.2-3.8). No association was observed between tumor SUVmax and PFS or OS. CONCLUSION: Baseline tumor burden (TMTV) on FDG PET/CT scans and inflammatory status (dNLR) were associated with poor OS and absence of DCB for ICI treatment in advanced NSCLCpatients, unlike tumor SUVmax, and may be used together to improve the selection of appropriate candidates.
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