Abstract
Our aim was to analyse whether biomarkers extracted from baseline 18F-FDG PET before anti-PD1 treatment contribute to prognostic survival information for early risk stratification in metastatic melanoma. Fifty-six patients, without prior systemic treatment, BRAF wild type, explored using 18F-FDG PET were included retrospectively. Our primary endpoint was overall survival (OS). Total metabolic tumoral volume (MTV) and forty-one IBSI compliant parameters were extracted from PET. Parameters associated with outcome were evaluated by a cox regression model and when significant helped build a prognostic score. Median follow-up was 22.1 months and 21 patients died. Total MTV and long zone emphasis (LZE) correlated with shorter OS and served to define three risk categories for the prognostic score. For low, intermediate and high risk groups, survival rates were respectively 91.1% (IC 95 80–1), 56.1% (IC 95 37.1–85) and 19% (IC 95 0.06–60.2) and hazard ratios were respectively 0.11 (IC 95 0.025–0.46), P = 0.0028, 1.2 (IC 95 0.48–2.8), P = 0.74 and 5.9 (IC 95 2.5–14), P < 0.0001. To conclude, a prognostic score based on total MTV and LZE separated metastatic melanoma patients in 3 categories with dramatically different outcomes. Innovative therapies should be tested in the group with the lowest prognosis score for future clinical trials.
Highlights
Our aim was to analyse whether biomarkers extracted from baseline 18F-FDG PET before anti-PD1 treatment contribute to prognostic survival information for early risk stratification in metastatic melanoma
Our results add to the accumulating evidence that beyond initial staging, 18F-FDG PET-CT scan provides simple to use and cost-effective biomarkers associated with overall survival (OS)
long zone emphasis (LZE) and total metabolic tumoral volume (MTV) demonstrated their high prognostic value in metastatic melanoma patients treated with anti-PD1
Summary
Our aim was to analyse whether biomarkers extracted from baseline 18F-FDG PET before anti-PD1 treatment contribute to prognostic survival information for early risk stratification in metastatic melanoma. A prognostic score based on total MTV and LZE separated metastatic melanoma patients in 3 categories with dramatically different outcomes. Only subsets of patients will benefit from it1: we need to develop tools predicting patient survival after immunotherapy to prevent toxicities and hasten the introduction of more appropriate treatments when necessary To answer this question different biomarkers have been analysed such as levels of programmed cell death ligand 1 (PDL1) expression[3], presence of tumour infiltrating lymphocytes[4], genetic mutations[5] and inflammatory cytokines[6]. 18F-labeled fluorodeoxyglucose positron emission tomography -computed tomography (18F FDG PET-CT) provides valuable functional information based on the increased glucose uptake and glycolysis of metastatic melanoma cells10. 18F FDG PET-CT is commonly used for the initial staging of metastatic melanomas
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