Norbert Galldiks1,2,3, Diana S Y Abdulla2,4, Matthias Scheffler2,4, Fabian Wolpert5, Jan-Michael Werner6, Martin Hüllner7, Gabriele Stoffels3, Viola Schweinsberg2,8, Max Schlaak2,8, Nicole Kreuzberg2,8, Jennifer Landsberg2,9, Philipp Lohmann3,10, Garry Ceccon6, Christian Baues2,11, Maike Trommer2,11, Eren Celik2,10, Maximilian I Ruge2,10, Martin Kocher3,10, Simone Marnitz2,11, Gereon R Fink6,3, Jörg-Christian Tonn12, Michael Weller5, Karl-Josef Langen3,13, Jürgen Wolf2,4, Cornelia Mauch2,8. 1. Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany norbert.galldiks@uk-koeln.de. 2. Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany. 3. Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany. 4. Lung Cancer Group, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 5. Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland. 6. Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 7. Department of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland. 8. Department of Dermatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 9. Department of Dermatology, University Hospital Bonn, Bonn, Germany. 10. Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 11. Department of Radiation Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 12. Department of Neurosurgery, University Hospital LMU Munich, Munich, Germany; and. 13. Department of Nuclear Medicine, RWTH University Hospital Aachen, Aachen, Germany.
Abstract
We investigated the value of O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) PET for treatment monitoring of immune checkpoint inhibition (ICI) or targeted therapy (TT) alone or in combination with radiotherapy in patients with brain metastasis (BM) since contrast-enhanced MRI often remains inconclusive. Methods: We retrospectively identified 40 patients with 107 BMs secondary to melanoma (n = 29 with 75 BMs) or non-small cell lung cancer (n = 11 with 32 BMs) treated with ICI or TT who had 18F-FET PET (n = 60 scans) for treatment monitoring from 2015 to 2019. Most patients (n = 37; 92.5%) had radiotherapy during the course of the disease. In 27 patients, 18F-FET PET was used to differentiate treatment-related changes from BM relapse after ICI or TT. In 13 patients, 18F-FET PET was performed for response assessment to ICI or TT using baseline and follow-up scans (median time between scans, 4.2 mo). In all lesions, static and dynamic 18F-FET PET parameters were obtained (i.e., mean tumor-to-brain ratios [TBR], time-to-peak values). Diagnostic accuracies of PET parameters were evaluated by receiver-operating-characteristic analyses using the clinical follow-up or neuropathologic findings as a reference. Results: A TBR threshold of 1.95 differentiated BM relapse from treatment-related changes with an accuracy of 85% (P = 0.003). Metabolic responders to ICI or TT on 18F-FET PET had a significantly longer stable follow-up (threshold of TBR reduction relative to baseline, ≥10%; accuracy, 82%; P = 0.004). Furthermore, at follow-up, time to peak in metabolic responders increased significantly (P = 0.019). Conclusion: 18F-FET PET may add valuable information for treatment monitoring in BM patients treated with ICI or TT.
We investigated the value of O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) PET for treatment monitoring of immune checkpoint inhibition (ICI) or targeted therapy (TT) alone or in combination with radiotherapy in patients with brain metastasis (BM) since contrast-enhanced MRI often remains inconclusive. Methods: We retrospectively identified 40 patients with 107 BMs secondary to melanoma (n = 29 with 75 BMs) or non-small cell lung cancer (n = 11 with 32 BMs) treated with ICI or TT who had 18F-FET PET (n = 60 scans) for treatment monitoring from 2015 to 2019. Most patients (n = 37; 92.5%) had radiotherapy during the course of the disease. In 27 patients, 18F-FET PET was used to differentiate treatment-related changes from BM relapse after ICI or TT. In 13 patients, 18F-FET PET was performed for response assessment to ICI or TT using baseline and follow-up scans (median time between scans, 4.2 mo). In all lesions, static and dynamic 18F-FET PET parameters were obtained (i.e., mean tumor-to-brain ratios [TBR], time-to-peak values). Diagnostic accuracies of PET parameters were evaluated by receiver-operating-characteristic analyses using the clinical follow-up or neuropathologic findings as a reference. Results: A TBR threshold of 1.95 differentiated BM relapse from treatment-related changes with an accuracy of 85% (P = 0.003). Metabolic responders to ICI or TT on 18F-FET PET had a significantly longer stable follow-up (threshold of TBR reduction relative to baseline, ≥10%; accuracy, 82%; P = 0.004). Furthermore, at follow-up, time to peak in metabolic responders increased significantly (P = 0.019). Conclusion: 18F-FET PET may add valuable information for treatment monitoring in BM patients treated with ICI or TT.
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