18F-FDG PET/CT Reveals Disease Remission in a Patient With Ipilimumab-Refractory Advanced Melanoma Treated With Pembrolizumab

Sachpekidis, Christos; Hassel, Jessica C.; Dimitrakopoulou-Strauß, Antonia

doi:10.1097/rlu.0000000000001039

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…In previous studies on the use of PET-based response in melanoma patients treated with ICIs, as many as half the patients showing residual disease on CT had negative findings on 18 F-FDG PET (23)(24)(25)(26). Indeed, the risk for PD misclassification after ICIs was higher in initial observations, which found that 10% of melanoma patients who, during ipilimumab, would have been misclassified as PD by World Health Organization criteria showed a clinical response (including PR and SD) (27). Subsequently, the rate of pseudoprogression was reported as 0%-6% in NSCLC treated with ICIs, and at present, pseudoprogression should be considered mainly when the clinical condition of a patient in apparent radiologic progression is concomitantly improving (28,29).…”

Section: Discussionmentioning

confidence: 99%

Comparison Between ¹⁸F-FDG PET–Based and CT-Based Criteria in Non–Small Cell Lung Cancer Patients Treated with Nivolumab

et al. 2019

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Because of the peculiar mechanism of action of immune checkpoint inhibitors (ICIs), evaluation of the radiologic response to them in solid tumors presents many challenges. We aimed to compare evaluation of the first response to nivolumab by means of CT-based criteria with respect to 18 F-FDG PET response criteria in non-small cell lung cancer (NSCLC) patients. Methods: Seventy-two patients with advanced NSCLC were recruited in a single-institution ancillary trial within the expanded-access program (NCT02475382) for nivolumab. Patients underwent CT and 18 F-FDG PET at baseline and after 4 cycles (the first evaluation). In cases of progressive disease, an additional evaluation was performed after 2 further cycles to confirm progression. We evaluated the treatment response on CT using RECIST 1.1 and the immune-related response criteria (irRC) and on 18 F-FDG PET using PERCIST and immunotherapy-modified PERCIST. The concordance between CT-and PET-based criteria and the capability of each method to predict overall survival were evaluated. Results: Forty-eight of 72 patients were evaluable for a first response assessment with both PET-and CT-based criteria. We observed low concordance between CT-and PET-based criteria (κ-value of 0.346 and 0.355 between PERCIST and imPERCIST and RECIST, respectively. κ-value of 0.128 and 0.198 between PERCIST and imPERCIST and irRC, respectively). Regarding overall survival, irRC could more reliably distinguish responders from nonresponders. However, thanks to the prognostic value of partial metabolic response assessed by both PERCIST and immunotherapy-modified PERCIST, PET-based response maintained prognostic significance in patients classified as having progressive disease on the basis of irRC. Conclusion: Even though the present study did not support the routine use of 18 F-FDG PET in the general population of NSCLC patients treated with ICIs, the findings suggest that metabolic response assessment has added prognostic value, potentially improving therapeutic decision making.

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Section: Discussionmentioning

confidence: 99%

Comparison Between ¹⁸F-FDG PET–Based and CT-Based Criteria in Non–Small Cell Lung Cancer Patients Treated with Nivolumab

et al. 2019

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“…IrRECIST and iRECIST seem to better identify patients with unconventional response as false progressors 94. Metabolic imaging like positron emission tomography (PET) tracers as 18 F-fluorodeoxyglucose (FDG) are known to be taken up in inflammatory cells, what may predict response to immunotherapy better than CT 95–97…”

Section: Predictive Factors Of Response To Pembrolizumab and Selecmentioning

confidence: 99%

<p>Clinical utility of pembrolizumab in the management of advanced solid tumors: an evidence-based review on the emerging new data</p>

Rusquec

Calbiac

Robert

et al. 2019

CMAR

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Pembrolizumab is a full-length human immunoglobulin G4 (IgG4) monoclonal antibody directed against the immune checkpoint PD-1 to remove its binding with PD-L1 and thus to restore an anti-tumor immune response of T cells. Pembrolizumab is one of the most advanced immune checkpoint inhibitors for cancer care. Apart from rare and serious adverse effects, its favorable tolerance profile enables to treat fragile patients who have often no other choice than best supportive care. The effective retained dose of pembrolizumab is a venous administration of 200 mg every 3 weeks until disease progression, intolerance or up to 24 months. Pembrolizumab has already proven its efficacy and thus obtained marketing authorization in so-called hot or hypermutated tumors or tumors expressing PD-L1 such as melanomas, non-small cell lung cancers, urothelial carcinomas, cervical cancer, etc. Pembrolizumab is also authorized in the United States in the treatment of mismatch repair-deficient tumors or with microsatellite instability. The current challenge is to expand its use in tumor types that are supposed to be less immunogenic, for example, by attempting to warm up the tumor microenvironment, or by combining pembrolizumab with other molecules. An acceptable toxicity profile of such combinations remains to explore. We review here the current indications of this drug, the main prognostic and predictive factors of its efficacy as well as the potential forthcoming indications.

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“…This suggests that FDG-PET may reflect therapeutic efficacy by the immune checkpoint inhibitors, considering the results of a recent study that indicated that FDG uptake after administration of nivolumab was an independent prognostic factor, and PD-L1 expression or plasma concentration of nivolumab was not a predictor of early therapeutic efficacy [ 42 ]. FDG-PET is supposed to be useful for monitoring early response to anti-PD-1 antibody, and several reports in the literature show the value of monitoring the anti-tumor efficacy of immune-checkpoint inhibitors; however, optimal timing to evaluate efficacy remains to be addressed [ 43 , 44 ]. Increased clinical use of immune checkpoint inhibitors determined the necessity of creating appropriate evaluation criteria using FDG-PET.…”

Section: Therapeutic Monitoring With Fdg-petmentioning

confidence: 99%

Positron Emission Tomography for Response Evaluation in Microenvironment-Targeted Anti-Cancer Therapy

2020

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Therapeutic response is evaluated using the diameter of tumors and quantitative parameters of 2-[18F] fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET). Tumor response to molecular-targeted drugs and immune checkpoint inhibitors is different from conventional chemotherapy in terms of temporal metabolic alteration and morphological change after the therapy. Cancer stem cells, immunologically competent cells, and metabolism of cancer are considered targets of novel therapy. Accumulation of FDG reflects the glucose metabolism of cancer cells as well as immune cells in the tumor microenvironment, which differs among patients according to the individual immune function; however, FDG-PET could evaluate the viability of the tumor as a whole. On the other hand, specific imaging and cell tracking of cancer cell or immunological cell subsets does not elucidate tumor response in a complexed interaction in the tumor microenvironment. Considering tumor heterogeneity and individual variation in therapeutic response, a radiomics approach with quantitative features of multimodal images and deep learning algorithm with reference to pathologic and genetic data has the potential to improve response assessment for emerging cancer therapy.

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18F-FDG PET/CT Reveals Disease Remission in a Patient With Ipilimumab-Refractory Advanced Melanoma Treated With Pembrolizumab

Cited by 5 publications

References 8 publications

Comparison Between ¹⁸F-FDG PET–Based and CT-Based Criteria in Non–Small Cell Lung Cancer Patients Treated with Nivolumab

Comparison Between ¹⁸F-FDG PET–Based and CT-Based Criteria in Non–Small Cell Lung Cancer Patients Treated with Nivolumab

<p>Clinical utility of pembrolizumab in the management of advanced solid tumors: an evidence-based review on the emerging new data</p>

Positron Emission Tomography for Response Evaluation in Microenvironment-Targeted Anti-Cancer Therapy

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18F-FDG PET/CT Reveals Disease Remission in a Patient With Ipilimumab-Refractory Advanced Melanoma Treated With Pembrolizumab

Cited by 5 publications

References 8 publications

Comparison Between 18F-FDG PET–Based and CT-Based Criteria in Non–Small Cell Lung Cancer Patients Treated with Nivolumab

Comparison Between 18F-FDG PET–Based and CT-Based Criteria in Non–Small Cell Lung Cancer Patients Treated with Nivolumab

<p>Clinical utility of pembrolizumab in the management of advanced solid tumors: an evidence-based review on the emerging new data</p>

Positron Emission Tomography for Response Evaluation in Microenvironment-Targeted Anti-Cancer Therapy

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Product

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Comparison Between ¹⁸F-FDG PET–Based and CT-Based Criteria in Non–Small Cell Lung Cancer Patients Treated with Nivolumab

Comparison Between ¹⁸F-FDG PET–Based and CT-Based Criteria in Non–Small Cell Lung Cancer Patients Treated with Nivolumab