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. 2023 Jan 31;15(3):878.
doi: 10.3390/cancers15030878.

ITA-IMMUNO-PET: The Role of [18F]FDG PET/CT for Assessing Response to Immunotherapy in Patients with Some Solid Tumors

Laura Evangelista  1 , Andrea Bianchi  2 , Alessio Annovazzi  3 , Rosa Sciuto  3 , Silvia Di Traglia  3 , Matteo Bauckneht  4   5 , Francesco Lanfranchi  4   5 , Silvia Morbelli  4   5 , Anna Giulia Nappi  6 , Cristina Ferrari  6 , Giuseppe Rubini  6 , Stefano Panareo  7 , Luca Urso  8 , Mirco Bartolomei  8 , Davide D'Arienzo  9 , Tullio Valente  10 , Virginia Rossetti  11 , Paola Caroli  11 , Federica Matteucci  11 , Demetrio Aricò  12 , Michelangelo Bombaci  12 , Domenica Caponnetto  12 , Francesco Bertagna  13 , Domenico Albano  13 , Francesco Dondi  13 , Sara Gusella  14 , Alessandro Spimpolo  14 , Cinzia Carriere  15 , Michele Balma  2 , Ambra Buschiazzo  2 , Rosj Gallicchio  16 , Giovanni Storto  16 , Livia Ruffini  17 , Veronica Cervati  17 , Roberta Eufrasia Ledda  18 , Anna Rita Cervino  19 , Lea Cuppari  19 , Marta Burei  19 , Giuseppe Trifirò  20 , Elisabetta Brugola  20 , Carolina Arianna Zanini  21 , Alessandra Alessi  22 , Valentina Fuoco  22 , Ettore Seregni  22 , Désirée Deandreis  23 , Virginia Liberini  2   23 , Antonino Maria Moreci  24 , Salvatore Ialuna  24 , Sabina Pulizzi  24 , Maria Luisa De Rimini  9
Affiliations

ITA-IMMUNO-PET: The Role of [18F]FDG PET/CT for Assessing Response to Immunotherapy in Patients with Some Solid Tumors

Laura Evangelista et al. Cancers (Basel). .

Abstract

Aim: To examine the role of [18F]FDG PET/CT for assessing response to immunotherapy in patients with some solid tumors.

Methods: Data recorded in a multicenter (n = 17), retrospective database between March and November 2021 were analyzed. The sample included patients with a confirmed diagnosis of a solid tumor who underwent serial [18F]FDG PET/CT (before and after one or more cycles of immunotherapy), who were >18 years of age, and had a follow-up of at least 12 months after their first PET/CT scan. Patients enrolled in clinical trials or without a confirmed diagnosis of cancer were excluded. The authors classified cases as having a complete or partial metabolic response to immunotherapy, or stable or progressive metabolic disease, based on a visual and semiquantitative analysis according to the EORTC criteria. Clinical response to immunotherapy was assessed at much the same time points as the serial PET scans, and both the obtained responses were compared.

Results: The study concerned 311 patients (median age: 67; range: 31-89 years) in all. The most common neoplasm was lung cancer (56.9%), followed by malignant melanoma (32.5%). Nivolumab was administered in 46.3%, and pembrolizumab in 40.5% of patients. Baseline PET and a first PET scan performed at a median 3 months after starting immunotherapy were available for all 311 patients, while subsequent PET scans were obtained after a median 6, 12, 16, and 21 months for 199 (64%), 102 (33%), 46 (15%), and 23 (7%) patients, respectively. Clinical response to therapy was recorded at around the same time points after starting immunotherapy for 252 (81%), 173 (56%), 85 (27%), 40 (13%), and 22 (7%) patients, respectively. After a median 18 (1-137) months, 113 (36.3%) patients had died. On Kaplan-Meier analysis, metabolic responders on the first two serial PET scans showed a better prognosis than non-responders, while clinical response became prognostically informative from the second assessment after starting immunotherapy onwards.

Conclusions: [18F]FDG PET/CT could have a role in the assessment of response to immunotherapy in patients with some solid tumors. It can provide prognostic information and thus contribute to a patient's appropriate treatment. Prospective randomized controlled trials are mandatory.

Keywords: 18F-FDG; PET/CT; immune-related effects; immunotherapy; therapy response.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart for the selection of the final population.
Figure 2
Figure 2
(A) Kaplan–Meier curves for OS based on the first PET/CT scan and clinical examination after starting immunotherapy in 276 patients; (B) Kaplan–Meier curves for OS based on the second PET/CT scan and clinical examination in 190 patients. CMR = complete metabolic response; PMR = partial metabolic response; SMD = stable metabolic disease; PMD = progressive metabolic disease; Time was expressed in months.
Figure 3
Figure 3
Kaplan–Meier curves for OS based on the first PET/CT scan (A) and clinical examination (B), by type of cancer (n = 159 patients with lung cancer, n = 89 patients with malignant melanoma and n = 28 patients with other tumors). CMR = complete metabolic response; PMR = partial metabolic response; SMD = stable metabolic disease; PMD = progressive metabolic disease; Time was expressed in months.
See this image and copyright information in PMC

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