Tumor metabolic volume by 18F-FDG-PET as a prognostic predictor of first-line pembrolizumab for NSCLC patients with PD-L1 ≥ 50

• Published in: Scientific reports Vol. 10; no. 1; p. 14990
• Main Authors: Yamaguchi, Ou, Kaira, Kyoichi, Hashimoto, Kosuke, Mouri, Atsuto, Shiono, Ayako, Miura, Yu, Murayama, Yoshitake, Kobayashi, Kunihiko, Kagamu, Hiroshi, Kuji, Ichiei
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 14.09.2020; Nature Publishing Group
• Subjects: 631/250; 631/67; 692/4028; Humanities and Social Sciences; Immunotherapy; Lung cancer; Medical prognosis; Metabolism; Monoclonal antibodies; multidisciplinary; Multivariate analysis; PD-L1 protein; Polarization; Positron emission tomography; Science; Science (multidisciplinary); Targeted cancer therapy
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-71735-y

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 ( 18 F-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 18 F-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 (SUV max ) on 18 F-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 18 F-FDG uptake predicted the prognosis after first-line pembrolizumab treatment in patients with NSCLC and PD-L1 expression ≥ 50%, especially for adenocarcinoma.