Abstract
BackgroundWe reported previously the usefulness of 18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to predict prognosis of renal cell carcinoma (RCC) treated with molecular targeted agents. Herein we describe a preliminary research of nine patients who underwent FDG-PET/CT before and after initiation of nivolumab.MethodsPatients with metastatic RCC who were treated by nivolumab from October 2016 to March 2017 were enrolled in this study. All patients underwent FDG-PET/CT at baseline and 1 month as a first response assessment, and contrast-enhanced or non-contrast-enhanced CT scan at 4 month as a second response assessment. Logistic regression analysis was performed to assess the association of potential predictors, including age, gender, baseline diameter, baseline maximum standardized uptake value (SUVmax), lung or not lung metastasis, elevation of SUVmax at 1st assessment, and decrease in diameter at 1st assessment with the response at 2nd assessment (decrease in the diameter ≥ 30% or not).ResultsThere were 9 patients and 30 lesions. Mean days of first assessment with FDG-PET/CT and second assessment by CT scan from initiation of treatment were 32.3 ± 6.4, 115.5 ± 14.9, respectively. Lesions whose diameter decreased ≥30% at second assessment were defined as responding, and lesions whose diameter did not decrease ≥30% were defined as non-responding. There were 18 responding lesions, and 12 non-responding lesions. We compared change in diameter and SUVmax at first assessment with FDG-PET/CT, respectively. All lesions with decreased diameter and elevated SUVmax at first assessment with FDG-PET/CT showed responding at second assessment by CT scan, while most lesions with increased diameter and declined SUVmax at first assessment showed non-responding at second assessment. The multivariate logistic regression analyses revealed that only the elevation of SUVmax at 1 month was an independent predictor (P = 0.025, OR: 13.087, 95%CI: 1.373–124.716).ConclusionOur findings suggest that the early assessment using FDG-PET/CT can be effective to predict the response of RCC to nivolumab. However, larger prospective studies are needed to confirm these preliminary results.Trial registrationRegistered in University Hospital Medical Information Network in JAPAN [UMIN0000008141], registration date: 11 Jun 2012.
Highlights
We reported previously the usefulness of 18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to predict prognosis of renal cell carcinoma (RCC) treated with molecular targeted agents
Our findings suggest that the early assessment using FDG-PET/CT can be effective to predict the response of RCC to nivolumab
The patients with RCC who were planned to be treated by nivolumab in Yokohama City University from October 2016 to March 2017 were enrolled in this study with the written consent
Summary
We reported previously the usefulness of 18F-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) to predict prognosis of renal cell carcinoma (RCC) treated with molecular targeted agents. We describe a preliminary research of nine patients who underwent FDG-PET/CT before and after initiation of nivolumab. 150,000 patients around the world are assumed to die of kidney cancer each year [1]. Renal cell carcinoma (RCC) accounts for 2–3% of all cancer cases [3]. Tyrosine kinase inhibitors (TKIs) or mammalian target of rapamycin (mTOR) inhibitors were two major innovative drugs in the history of RCC treatment [6,7,8]. There are cases in which growth of RCC ceases, as if the cancer entered a period of dormancy after initiating those drugs. We do not have any practical markers that can reflect the biological activity of RCC
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