Abstract
Introduction: The aim of this study was to investigate whether [18F]FDG PET/CT-derived semi-quantitative parameters can predict immunotherapy treatment response in non-small cell lung cancer (NSCLC) patients. Secondly, immune-related adverse events (irAEs) and lymphoid cell-rich organs activation were evaluated. Materials and Methods: Twenty-eight patients who underwent [18F]FDG PET/CT scans before and at first restaging therapy with immuno-checkpoint inhibitors (ICIs) were retrospectively analyzed. PET-based semi-quantitative parameters extracted from both scans were respectively: SUVmax and SUVpeak of the target lesion, whole-body metabolic tumor volume (MTVWB), and whole-body total lesion glycolysis (TLGWB), as well as their interval changes (ΔSUVmaxTL, ΔSUVpeakTL, ΔMTVWB, ΔTLGWB). These PET-derived parameters were correlated to controlled disease (CD) assessed by RECIST 1.1. IrAEs, if present, were also described and correlated with clinical benefit (CB). SUVmax of the spleen and bone marrow at restaging scans were also correlated to CB. Results: The CD was achieved in 54% of patients. Out of 28 eligible patients, 13 (46%) experienced progressive disease (PD), 7 showed SD, 7 had PR, and only in one patient CR was achieved. ΔSUVmaxTL (p = 0.002) and ΔSUVpeakTL (p < 0.001) as well as ΔMTVWB (p < 0.001) and ΔTLGWB (p < 0.005) were significantly associated with PD vs. non-PD. IrAEs and lymphoid cell-rich organs activation did not correlate with CB. Conclusions: [18F]FDG PET/CT by using interval changes of PET-derived semi-quantitative parameters could represent a reliable tool in immunotherapy treatment response evaluation in NSCLC patients.
Highlights
In the last decade, the advent of immunotherapy has paved the way for new treatment options for patients with advanced non-small cell lung cancer (NSCLC) [1]
The advent of immunotherapy in clinical practice and the approval of several drugs for advanced solid tumors led to the development of new challenges for imaging
This study pointed out that metabolic changes during immunotherapy statistically correlate with treatment response as well as with clinical benefit (CB)
Summary
The advent of immunotherapy has paved the way for new treatment options for patients with advanced non-small cell lung cancer (NSCLC) [1]. Immunocheckpoint inhibitors (ICIs) therapy exploits the use of antibodies that target specific molecules involved in tumor signaling, determining the suppression of cytotoxic T lymphocytes [2]. By releasing the brakes of the host-immune system, ICIs may alter the physiological homeostasis of immune response, leading to the development of immune-related adverse events (irAEs) [3]. A standard method to evaluate the success of these innovative therapies and to identify patients who may benefit from them remains undetermined. Solid Tumors (RECIST1.1) represents the standard modality to cytotoxic therapies response assessment [4]. To face this new clinical issue, the immune-related Response Evaluation
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