Introduction: Immune checkpoint inhibitors (ICIs) have become the standard of care in the management of advanced non–small cell lung cancer (NSCLC). Nevertheless, only a small proportion of patients benefit from ICIs. The aim of the present study is to assess whether 2-deoxy-2-[18F]fluoro-D-GLUCOSE POSITRON EMISSION TOMOGRAPHY-COMPUTED TOMOGRAPHY ([18F]FDG-PET/CT)–derived parameters may be used as biomarkers in patients with advanced NSCLC receiving first-line pembrolizumab. Materials and methods: This is a monocentric retrospective cohort study including patients with advanced NSCLC (stage IV) and Programmed death-ligand 1 (PD-L1) expression ≥50% treated with pembrolizumab. A control group of patients treated with epidermal growth factor receptor (EGFR) inhibitors for EGFR-mutated NSCLC was also enrolled. Only patients with a positive [18F]18F-FDG PET/CT result within 60 days from treatment initiation were included.Total metabolic tumour volume (tMTV) was calculated for each lesion using a dedicated software (PET VCAR; GE Healthcare), which semiautomatically delineates the tumour's contours with a maximum standardised uptake value (SUVmax) threshold of 42% within the lesion. tMTV was obtained summing each lesion's MTV. Potential prognostic parameters for overall survival (OS) were analysed (tMTV, SUVmax, bone/liver metastasis, neutrophil:lymphocyte ratio ≥4, Eastern Cooperative Oncology Group performance status ≥2, lactate dehydrogenase above the upper limit of normal). Results: Overall, 34 patients treated with first line-pembrolizumab and 40 patients treated with EGFR tyrosine kinase inhibitors were included. In the pembrolizumab group, the median follow-up was 20.3, while the median OS was 4.7 months (95% confidence interval [CI] = 0.3–9.1) for patients with tMTV ≥75 cm3 vs not reached (NR) for patients with tMTV <75 cm3 (95% CI = NR–NR; hazard ratio [HR] = 5.37; 95% CI = 1.72–16.77; p = 0.004). No difference was found in the control group (HR = 1.43; 95% CI = 0.61–3.34; p = 0.411). Conclusion: Our data suggest that tMTV ≥75cm3 can be used as a prognostic biomarker of poor outcomes in patients with PD-L1–high advanced NSCLC treated with first-line pembrolizumab. This information could be useful for the selection of patients who may require the addition of chemotherapy to pembrolizumab.

Baseline total metabolic tumour volume on 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography-computed tomography as a promising biomarker in patients with advanced non-small cell lung cancer treated with first-line pembrolizumab.

Dall'Olio FG;Calabrò D;Conci N;Argalia G;Marchese PV;Fragomeno B;Fanti S;Ambrosini V;Ardizzoni A.
2021

Abstract

Introduction: Immune checkpoint inhibitors (ICIs) have become the standard of care in the management of advanced non–small cell lung cancer (NSCLC). Nevertheless, only a small proportion of patients benefit from ICIs. The aim of the present study is to assess whether 2-deoxy-2-[18F]fluoro-D-GLUCOSE POSITRON EMISSION TOMOGRAPHY-COMPUTED TOMOGRAPHY ([18F]FDG-PET/CT)–derived parameters may be used as biomarkers in patients with advanced NSCLC receiving first-line pembrolizumab. Materials and methods: This is a monocentric retrospective cohort study including patients with advanced NSCLC (stage IV) and Programmed death-ligand 1 (PD-L1) expression ≥50% treated with pembrolizumab. A control group of patients treated with epidermal growth factor receptor (EGFR) inhibitors for EGFR-mutated NSCLC was also enrolled. Only patients with a positive [18F]18F-FDG PET/CT result within 60 days from treatment initiation were included.Total metabolic tumour volume (tMTV) was calculated for each lesion using a dedicated software (PET VCAR; GE Healthcare), which semiautomatically delineates the tumour's contours with a maximum standardised uptake value (SUVmax) threshold of 42% within the lesion. tMTV was obtained summing each lesion's MTV. Potential prognostic parameters for overall survival (OS) were analysed (tMTV, SUVmax, bone/liver metastasis, neutrophil:lymphocyte ratio ≥4, Eastern Cooperative Oncology Group performance status ≥2, lactate dehydrogenase above the upper limit of normal). Results: Overall, 34 patients treated with first line-pembrolizumab and 40 patients treated with EGFR tyrosine kinase inhibitors were included. In the pembrolizumab group, the median follow-up was 20.3, while the median OS was 4.7 months (95% confidence interval [CI] = 0.3–9.1) for patients with tMTV ≥75 cm3 vs not reached (NR) for patients with tMTV <75 cm3 (95% CI = NR–NR; hazard ratio [HR] = 5.37; 95% CI = 1.72–16.77; p = 0.004). No difference was found in the control group (HR = 1.43; 95% CI = 0.61–3.34; p = 0.411). Conclusion: Our data suggest that tMTV ≥75cm3 can be used as a prognostic biomarker of poor outcomes in patients with PD-L1–high advanced NSCLC treated with first-line pembrolizumab. This information could be useful for the selection of patients who may require the addition of chemotherapy to pembrolizumab.
Dall'Olio FG, Calabrò D, Conci N, Argalia G, Marchese PV, Fabbri F, Fragomeno B, Ricci D, Fanti S, Ambrosini V, Ardizzoni A.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11585/856399
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