Abstract
Simple SummaryThis is the first known study to compare three FDG-PET/CT criteria (EORTC, PERCIST, imPERCIST) with CT criteria (combined modified RECIST and RECIST 1.1) used to evaluate tumor response to ICI therapy in patients with recurrent MPM as well as prediction of prognosis. All of the FDG-PET/CT and CT criteria analyzed were found to be accurate for both evaluation of tumor response and prediction of progression free survival in the present cohort. In comparison with CT, all three FDG-PET/CT criteria judged a greater percentage of patients (16.7%) as CR, while two (EORTC, PERCIST) judged a greater percentage (10–13.3%) as PD.Background: To compare three FDG-PET criteria (EORTC, PERCIST, imPERCIST) with CT criteria (combined modified RECIST and RECIST 1.1) for response evaluation and prognosis prediction in patients with recurrent MPM treated with ICI monotherapy. Methods: Thirty MPM patients underwent FDG-PET/CT and contrast-enhanced CT at the baseline and during nivolumab therapy (median 10 cycles). Therapeutic response was evaluated according to EORTC, PERCIST, imPERCIST, and CT criteria. PFS and OS were examined using log-rank and Cox methods. Results: CMR/PMR/SMD/PMD numbered 5/3/4/18 for EORTC, 5/1/7/17 for PERCIST, and 5/3/9/13 for imPERCIST. With CT, CR/PR/SD/PD numbered 0/6/10/14. There was high concordance between EORTC and PERCIST (κ = 0.911), and PERCIST and imPERCIST (κ = 0.826), while that between EORTC and imPERCIST (κ = 0.746) was substantial, and between CT and the three PET criteria moderate (κ = 0.516–0.544). After median 14.9 months, 26 patients showed progression and nine died. According to both PET and CT findings, patients with no progression (CMR/PMR/SMD or CR/PR/SD) showed significantly longer PFS and somewhat longer OS than PMD and PD patients (EORTC p = 0.0004 and p = 0.055, respectively; PERCIST p = 0.0003 and p = 0.052; imPERCIST p < 0.0001 and p = 0.089; CT criteria p = 0.0015 and p = 0.056). Conclusions: Both FDG-PET and CT criteria are accurate for response evaluation of ICI therapy and prediction of MPM prognosis. In comparison with CT, all three FDG-PET/CT criteria judged a greater percentage of patients (16.7%) as CMR, while two (EORTC, PERCIST) judged a greater percentage (10–13.3%) as PMD. For predicting PFS, the three FDG-PET criteria were superior to the CT criteria, and imPERCIST demonstrated the highest rate of accurate prediction.
Highlights
Individuals affected by malignant pleural mesothelioma (MPM), a rare type of aggressive malignancy, have a poor prognosis
For predicting Progressionfree survival (PFS), the three FDG-PET criteria were superior to the computed tomography (CT) criteria and imPERCIST demonstrated the highest rate of accurate were superior to the CT criteria and imPERCIST demonstrated the highest rate of accurate prediction
Results of 28 non-small cell lung cancer patients who were receiving nivolumab were analyzed and indicated that any metabolic progression observed at eight weeks should be confirmed by another FDG-PET/CT examination performed four weeks later, while they noted that iPERCIST was useful for differentiation of responders from non-responders and Overall survival (OS) prediction (p = 0.0003)
Summary
Individuals affected by malignant pleural mesothelioma (MPM), a rare type of aggressive malignancy, have a poor prognosis. A paradigm shift has occurred in recent years because of development of immune checkpoint inhibitors (ICIs), and several groups have reported survival benefits for patients with recurrent MPM [1,2,3,4,5]. Those include a single-arm phase II study conducted in Japan (MERIT study) that examined nivolumab (anti-PD-1 monoclonal antibody) monotherapy for efficacy and safety in 34 MPM patients with a history of chemotherapy, with their findings leading to approval of nivolumab for unresectable recurrent MPM treatment in Japan [3].
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