18 FDG PET/CT in the early assessment of non-small cell lung cancer response to immunotherapy: frequency and clinical significance of atypical evolutive patterns
This prospective study aimed (1) to assess the non-small cell lung cancer (NSCLC) evolutive patterns to immunotherapy using FDG-PET and (2) to describe their association with clinical outcome. Fifty patients with metastatic NSCLC were included before pembrolizumab or nivolumab initiation. FDG-PET sc...
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Published in | European journal of nuclear medicine and molecular imaging Vol. 47; no. 5; p. 1158 |
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Main Authors | , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Germany
01.05.2020
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Abstract | This prospective study aimed (1) to assess the non-small cell lung cancer (NSCLC) evolutive patterns to immunotherapy using FDG-PET and (2) to describe their association with clinical outcome.
Fifty patients with metastatic NSCLC were included before pembrolizumab or nivolumab initiation. FDG-PET scan was performed at baseline and after 7 weeks of treatment (PET
1) and different criteria/parameters of tumor response were assessed, including PET response criteria in solid tumors (PERCIST). If a first PERCIST progressive disease (PD) without clinical worsening was observed, treatment was continued and a subsequent FDG-PET (PET
2) was performed at 3 months of treatment. Pseudo-progression (PsPD) was defined as a PERCIST response/stability on PET
2 after an initial PD. If a second PERCIST PD was assessed on PET
2, a homogeneous progression of lesions (termed immune homogeneous progressive-disease: iPD
) was distinguished from a heterogeneous evolution (termed immune dissociated-response: iDR). A durable clinical benefit (DCB) of immunotherapy was defined as treatment continuation over a 6-month period. The association between PET evolutive profiles and DCB was assessed.
Using PERCIST on PET
1, 42% (21/50) of patients showed a response or stable disease, most of them (18/21) reached a DCB. In contrast, 58% (29/50) showed a PD, but more than one-third (11/29) were misclassified as they finally reached a DCB. No standard PET
1 criteria could accurately distinguished responding from non-responding patients. Treatment was continued in 19/29 of patients with a first PERCIST PD; the subsequent PET
2 demonstrated iPD
, iDR and PsPD in 42% (8/19), 26% (5/19), and 32% (6/19), respectively. Whereas no patients with iPD
experienced a DCB, all patients with iDR and PsPD reached a clinical benefit to immunotherapy.
In patients with a first PD on PERCIST and treatment continuation, a subsequent PET identifies more than half of them with iDR and PsPD, both patterns being strongly associated with a clinical benefit of immunotherapy. |
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AbstractList | This prospective study aimed (1) to assess the non-small cell lung cancer (NSCLC) evolutive patterns to immunotherapy using FDG-PET and (2) to describe their association with clinical outcome.
Fifty patients with metastatic NSCLC were included before pembrolizumab or nivolumab initiation. FDG-PET scan was performed at baseline and after 7 weeks of treatment (PET
1) and different criteria/parameters of tumor response were assessed, including PET response criteria in solid tumors (PERCIST). If a first PERCIST progressive disease (PD) without clinical worsening was observed, treatment was continued and a subsequent FDG-PET (PET
2) was performed at 3 months of treatment. Pseudo-progression (PsPD) was defined as a PERCIST response/stability on PET
2 after an initial PD. If a second PERCIST PD was assessed on PET
2, a homogeneous progression of lesions (termed immune homogeneous progressive-disease: iPD
) was distinguished from a heterogeneous evolution (termed immune dissociated-response: iDR). A durable clinical benefit (DCB) of immunotherapy was defined as treatment continuation over a 6-month period. The association between PET evolutive profiles and DCB was assessed.
Using PERCIST on PET
1, 42% (21/50) of patients showed a response or stable disease, most of them (18/21) reached a DCB. In contrast, 58% (29/50) showed a PD, but more than one-third (11/29) were misclassified as they finally reached a DCB. No standard PET
1 criteria could accurately distinguished responding from non-responding patients. Treatment was continued in 19/29 of patients with a first PERCIST PD; the subsequent PET
2 demonstrated iPD
, iDR and PsPD in 42% (8/19), 26% (5/19), and 32% (6/19), respectively. Whereas no patients with iPD
experienced a DCB, all patients with iDR and PsPD reached a clinical benefit to immunotherapy.
In patients with a first PD on PERCIST and treatment continuation, a subsequent PET identifies more than half of them with iDR and PsPD, both patterns being strongly associated with a clinical benefit of immunotherapy. |
Author | Chardin, D Otto, J Borchiellini, D Schiappa, R Benisvy, D Zwarthoed, C Cadour, N Poudenx, M Ouvrier, M J Humbert, O Ilie, M Ghalloussi, H Paquet, M Darcourt, J Schiazza, A Koulibaly, P M |
Author_xml | – sequence: 1 givenname: O orcidid: 0000-0003-4440-5416 surname: Humbert fullname: Humbert, O email: olivier.humbert@univ-cotedazur.fr, olivier.humbert@univ-cotedazur.fr organization: Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), UMR E 4320, CEA, UCA, Nice, France. olivier.humbert@univ-cotedazur.fr – sequence: 2 givenname: N surname: Cadour fullname: Cadour, N organization: Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France – sequence: 3 givenname: M surname: Paquet fullname: Paquet, M organization: Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France – sequence: 4 givenname: R surname: Schiappa fullname: Schiappa, R organization: Department of Biostatistics, Centre Antoine-Lacassagne, UCA, Nice, France – sequence: 5 givenname: M surname: Poudenx fullname: Poudenx, M organization: Department of Medical Oncology, Centre Antoine-Lacassagne, UCA, Nice, France – sequence: 6 givenname: D surname: Chardin fullname: Chardin, D organization: Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), UMR E 4320, CEA, UCA, Nice, France – sequence: 7 givenname: D surname: Borchiellini fullname: Borchiellini, D organization: Clinical Research and Innovation Office, Centre Antoine-Lacassagne, UCA, Nice, France – sequence: 8 givenname: D surname: Benisvy fullname: Benisvy, D organization: Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France – sequence: 9 givenname: M J surname: Ouvrier fullname: Ouvrier, M J organization: Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France – sequence: 10 givenname: C surname: Zwarthoed fullname: Zwarthoed, C organization: Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France – sequence: 11 givenname: A surname: Schiazza fullname: Schiazza, A organization: Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France – sequence: 12 givenname: M surname: Ilie fullname: Ilie, M organization: Laboratory of Clinical and Experimental Pathology, Hospital-Integrated Biobank (BB-0033-00025), Nice Hospital University, FHU OncoAge, UCA, Nice, France – sequence: 13 givenname: H surname: Ghalloussi fullname: Ghalloussi, H organization: Department of Medical Oncology, Centre Antoine-Lacassagne, UCA, Nice, France – sequence: 14 givenname: P M surname: Koulibaly fullname: Koulibaly, P M organization: Department of Nuclear Medicine, Centre Antoine-Lacassagne, Université Côte d'Azur (UCA), 33 Avenue de Valombrose, 06189, Nice, France – sequence: 15 givenname: J surname: Darcourt fullname: Darcourt, J organization: Laboratory Transporter in Imaging and Radiotherapy in Oncology (TIRO), UMR E 4320, CEA, UCA, Nice, France – sequence: 16 givenname: J surname: Otto fullname: Otto, J organization: Department of Medical Oncology, Centre Antoine-Lacassagne, UCA, Nice, France |
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Snippet | This prospective study aimed (1) to assess the non-small cell lung cancer (NSCLC) evolutive patterns to immunotherapy using FDG-PET and (2) to describe their... |
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SubjectTerms | Carcinoma, Non-Small-Cell Lung - diagnostic imaging Carcinoma, Non-Small-Cell Lung - therapy Fluorodeoxyglucose F18 Humans Immunotherapy Lung Neoplasms - diagnostic imaging Lung Neoplasms - therapy Positron Emission Tomography Computed Tomography Positron-Emission Tomography Prospective Studies Treatment Outcome |
Title | 18 FDG PET/CT in the early assessment of non-small cell lung cancer response to immunotherapy: frequency and clinical significance of atypical evolutive patterns |
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