Abstract
ObjectiveIn malignant melanoma patients treated with immune checkpoint inhibitor (ICI) therapy, three different FDG-PET criteria, European Organization for Research and Treatment of Cancer (EORTC), PET Response Criteria in Solid Tumors (PERCIST), immunotherapy-modified PERCIST (imPERCIST), were compared regarding response evaluation and prognosis prediction using standardized uptake value (SUV) harmonization of results obtained with various PET/CT scanners installed at different centers.Materials and methodsMalignant melanoma patients (n = 27) underwent FDG-PET/CT examinations before and again 3 to 9 months after therapy initiation (nivolumab, n = 21; pembrolizumab, n = 6) with different PET scanners at five hospitals. EORTC, PERCIST, and imPERCIST criteria were used to evaluate therapeutic response, then concordance of the results was assessed using Cohen’s κ coefficient. Log-rank and Cox methods were employed to determine progression-free (PFS) and overall (OS) survival.ResultsComplete metabolic response (CMR)/partial metabolic response (PMR)/stable metabolic disease (SMD)/progressive metabolic disease (PMD) with harmonized EORTC, PERCIST, and imPERCIST was seen in 3/5/4/15, 4/5/3/15, and 4/5/5/13 patients, respectively. Nearly perfect concordance between each pair of criteria was noted (κ = 0.939–0.972). Twenty patients showed progression and 14 died from malignant melanoma after a median 19.2 months. Responders (CMR/PMR) showed significantly longer PFS and OS than non-responders (SMD/PMD) (harmonized EORTC: p < 0.0001 and p = 0.011; harmonized PERCIST: p < 0.0001 and p = 0.0012; harmonized imPERCIST: p < 0.0001 and p = 0.0012, respectively).ConclusionsAll harmonized FDG-PET criteria (EORTC, PERCIST, imPERCIST) showed accuracy for response evaluation of ICI therapy and prediction of malignant melanoma patient prognosis. Additional studies to determine their value in larger study populations will be necessary.
Highlights
Recent breakthrough results from use of immune checkpoint inhibitors (ICIs) have provided a leap forward, which has led to a new era of cancer immunotherapy and cancer treatmentExtended author information available on the last page of the article paradigm shift [1]
Several recent studies have found the utility of baseline and follow-up 18F-fludeoxyglucose (18FFDG) positron emission tomography/computed tomography (PET/CT) results for assessing therapeutic response in cases of malignant melanoma treated with an ICI and prognosis prediction [3,4,5,6]
Baseline 18F-FDG PET/CT scanning was performed at a median 27 days (2–90 days) before ICI therapy initiation, while follow-up scanning was done at a median 147 days (90–269 days) following the first ICI administration
Summary
Recent breakthrough results from use of immune checkpoint inhibitors (ICIs) have provided a leap forward, which has led to a new era of cancer immunotherapy and cancer treatmentExtended author information available on the last page of the article paradigm shift [1]. Several recent studies have found the utility of baseline and follow-up 18F-fludeoxyglucose (18FFDG) positron emission tomography/computed tomography (PET/CT) results for assessing therapeutic response in cases of malignant melanoma treated with an ICI and prognosis prediction [3,4,5,6]. Widespread use of PET for determining treatment response has been limited by differences in the range of SUV among different available PET scanners. Harmonization among PET models has been used [9, 10] Another important issue is that until now, treatment response evaluations of patients treated with ICIs have been performed at a single center, while data obtained at multiple centers using various PET scanners have not been utilized. It is considered that more widespread use of PET to determine efficacy could occur should varied PET data obtained at multiple institutions be integrated to better determine treatment response
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