Tumor metabolic volume by 18F-FDG-PET as a prognostic predictor of first-line pembrolizumab for NSCLC patients with PD-L1\xa0\u2265\xa050%

Ou Yamaguchi,Atsuto Mouri,Kosuke Hashimoto,Hiroshi Kagamu,Kunihiko Kobayashi,Yoshitake Murayama,Yu Miura,Ichiei Kuji,Kyoichi Kaira,Ayako Shiono

doi:10.1038/s41598-020-71735-y

Ou Yamaguchi, Atsuto Mouri + Show 8 more

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https://doi.org/10.1038/s41598-020-71735-y

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Journal: Scientific Reports	Publication Date: Sep 14, 2020
Citations: 26	License type: open-access

Affiliation: Saitama Medical University

Abstract

There is a lack of markers for predicting favorable outcomes after pembrolizumab therapy in patients with non-small cell lung cancer (NSCLC) with programmed death ligand-1 (PD-L1) expression ≥ 50%. This retrospective study examined the prognostic significance of 2-deoxy-2-[18F] fluoro-d-glucose (18F-FDG) uptake as a predictive marker of first-line pembrolizumab. Forty-eight patients with previously untreated NSCLC and PD-L1 expression levels ≥ 50% who underwent 18F-FDG-positron emission tomography (PET) just before administration of pembrolizumab monotherapy were eligible and underwent assessment of metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum of standardized uptake value (SUVmax) on 18F-FDG uptake. The objective response rate, median progression-free survival, and median overall survival were 51.1%, 7.1 months, and 18.6 months, respectively. In univariate survival analyses, high MTV was barely a significant prognostic predictor and was confirmed as an independent factor linked to worse outcomes in multivariate analysis, predominantly in patients with a histological diagnosis of adenocarcinoma. A high MTV was significantly associated with distant metastases (especially bone metastasis), C-reactive protein (CRP) level, and PD-L1 expression ≥ 75%. Metabolic tumor activity assessed as MTV from 18F-FDG uptake predicted the prognosis after first-line pembrolizumab treatment in patients with NSCLC and PD-L1 expression ≥ 50%, especially for adenocarcinoma.

Highlights

There is a lack of markers for predicting favorable outcomes after pembrolizumab therapy in patients with non-small cell lung cancer (NSCLC) with programmed death ligand-1 (PD-L1) expression ≥ 50%
A recent meta-analysis proposed that metabolic parameters such as total lesion glycolysis (TLG) and metabolic tumor volume (MTV) are better predictors of outcome after treatment compared to the maximum standardized uptake values ( SUVmax) in lung c ancer[8]
Kaplan–Meier survival curves are shown in Figs. 1 and 2. This is the first study to show that metabolic tumor activity, as assessed by MTV, could predict outcome in patients with advanced NSCLC with PD-L1 expressions ≥ 50%

Summary

Introduction

There is a lack of markers for predicting favorable outcomes after pembrolizumab therapy in patients with non-small cell lung cancer (NSCLC) with programmed death ligand-1 (PD-L1) expression ≥ 50% This retrospective study examined the prognostic significance of 2-deoxy-2-[18F] fluoro-d-glucose (18F-FDG) uptake as a predictive marker of first-line pembrolizumab. If the accumulation of 18F-FDG within tumor cells can be used to predict outcomes after initiation of anti-PD-1 antibody monotherapy, the usefulness and convenience of 18F-FDG PET make it a potential predictive factor for ICIs. In daily practice, PD-L1 expression is assessed by immunohistochemistry before initiation of anti-PD-1/PD-L1 therapy as a predictive marker; fewer than half of patients with PD-L1 expression ≥ 50% showed an objective response and approximately 20% experienced progressive d isease[2]. We retrospectively examined the prognostic significance of FDG-PET to predict response to firstline pembrolizumab monotherapy in patients with untreated advanced NSCLC with PD-L1 expression ≥ 50%

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