Giovanni Rossi1,2, Matteo Bauckneht3, Carlo Genova1, Erika Rijavec4, Federica Biello1, Simone Mennella5, Maria Giovanna Dal Bello1, Giuseppe Cittadini5, Paolo Bruzzi6, Roberta Piva3, Valentina Ceriani3, Gianmario Sambuceti3,7, Egesta Lopci8, Silvia Morbelli9,7, Francesco Grossi4. 1. Lung Cancer Unit, IRCCS Policlinico San Martino, Genoa, Italy. 2. Department of Clinical, Surgical, and Experimental Sciences, Division of Experimental Pathology and Oncology, University of Sassari, Sassari, Italy. 3. Nuclear Medicine Unit, IRCCS Policlinico San Martino, Genoa, Italy. 4. Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 5. Radiology Unit, IRCCS Policlinico San Martino, Genoa, Italy. 6. Epidemiology Unit, IRCCS Policlinico San Martino, Genoa, Italy. 7. Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; and. 8. Nuclear Medicine Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy. 9. Nuclear Medicine Unit, IRCCS Policlinico San Martino, Genoa, Italy silvia.morbelli@unige.it.
Abstract
Because of the peculiar mechanism of action of immune checkpoint inhibitors (ICIs), evaluation of the radiologic response to them in solid tumors presents many challenges. We aimed to compare evaluation of the first response to nivolumab by means of CT-based criteria with respect to 18F-FDG PET response criteria in non-small cell lung cancer (NSCLC) patients. Methods: Seventy-two patients with advanced NSCLC were recruited in a single-institution ancillary trial within the expanded-access program (NCT02475382) for nivolumab. Patients underwent CT and 18F-FDG PET at baseline and after 4 cycles (the first evaluation). In cases of progressive disease, an additional evaluation was performed after 2 further cycles to confirm progression. We evaluated the treatment response on CT using RECIST 1.1 and the immune-related response criteria (irRC) and on 18F-FDG PET using PERCIST and immunotherapy-modified PERCIST. The concordance between CT- and PET-based criteria and the capability of each method to predict overall survival were evaluated. Results: Forty-eight of 72 patients were evaluable for a first response assessment with both PET- and CT-based criteria. We observed low concordance between CT- and PET-based criteria (κ-value of 0.346 and 0.355 between PERCIST and imPERCIST and RECIST, respectively. κ-value of 0.128 and 0.198 between PERCIST and imPERCIST and irRC, respectively). Regarding overall survival, irRC could more reliably distinguish responders from nonresponders. However, thanks to the prognostic value of partial metabolic response assessed by both PERCIST and immunotherapy-modified PERCIST, PET-based response maintained prognostic significance in patients classified as having progressive disease on the basis of irRC. Conclusion: Even though the present study did not support the routine use of 18F-FDG PET in the general population of NSCLC patients treated with ICIs, the findings suggest that metabolic response assessment has added prognostic value, potentially improving therapeutic decision making.
Because of the peculiar mechanism of action of immune checkpoint inhibitors (ICIs), evaluation of the radiologic response to them in solid tumors presents many challenges. We aimed to compare evaluation of the first response to nivolumab by means of CT-based criteria with respect to 18F-FDG PET response criteria in non-small cell lung cancer (NSCLC) patients. Methods: Seventy-two patients with advanced NSCLC were recruited in a single-institution ancillary trial within the expanded-access program (NCT02475382) for nivolumab. Patients underwent CT and 18F-FDG PET at baseline and after 4 cycles (the first evaluation). In cases of progressive disease, an additional evaluation was performed after 2 further cycles to confirm progression. We evaluated the treatment response on CT using RECIST 1.1 and the immune-related response criteria (irRC) and on 18F-FDG PET using PERCIST and immunotherapy-modified PERCIST. The concordance between CT- and PET-based criteria and the capability of each method to predict overall survival were evaluated. Results: Forty-eight of 72 patients were evaluable for a first response assessment with both PET- and CT-based criteria. We observed low concordance between CT- and PET-based criteria (κ-value of 0.346 and 0.355 between PERCIST and imPERCIST and RECIST, respectively. κ-value of 0.128 and 0.198 between PERCIST and imPERCIST and irRC, respectively). Regarding overall survival, irRC could more reliably distinguish responders from nonresponders. However, thanks to the prognostic value of partial metabolic response assessed by both PERCIST and immunotherapy-modified PERCIST, PET-based response maintained prognostic significance in patients classified as having progressive disease on the basis of irRC. Conclusion: Even though the present study did not support the routine use of 18F-FDG PET in the general population of NSCLCpatients treated with ICIs, the findings suggest that metabolic response assessment has added prognostic value, potentially improving therapeutic decision making.
Authors: Lena M Mittlmeier; Matthias Brendel; Leonie Beyer; Nathalie L Albert; Andrei Todica; Mathias J Zacherl; Vera Wenter; Annika Herlemann; Alexander Kretschmer; Stephan T Ledderose; Nina-Sophie Schmidt-Hegemann; Wolfgang G Kunz; Jens Ricke; Peter Bartenstein; Harun Ilhan; Marcus Unterrainer Journal: Front Oncol Date: 2021-05-21 Impact factor: 6.244