18FDG PET Assessment of Therapeutic Response in Patients with Advanced or Metastatic Melanoma Treated with First-Line Immune Checkpoint Inhibitors

Rivas, Alexia; Delyon, Julie; Martineau, Antoine; Blanc, Estelle; Allayous, Clara; Meda, Laetitia Da; Merlet, Pascal; Lebbe, Célèste; Baroudjian, Barouyr; Vercellino, Laëtitia

doi:10.3390/cancers14133190

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…Respectively, when response to immunotherapy was defined by metabolic DCR, patients exhibiting disease control had a significantly longer survival than those with disease progression according to almost all metabolic criteria. These results come to substantiate previous works in the field reflecting the ability of metabolic response to ICIs, as assessed by [ 18 F]FDG PET/CT performed approximately 3–4 months after starting treatment, in stratifying longer-term patient outcome [ 23 , 34 ]. This time point for performing follow-up imaging appears sufficiently reliable, irrespective of the evaluation method used, and practical in terms of patient management.…”

Section: Discussionsupporting

confidence: 86%

The prognostic value of [18F]FDG PET/CT based response monitoring in metastatic melanoma patients undergoing immunotherapy: comparison of different metabolic criteria

Sachpekidis

Weru

Kopp‐Schneider

et al. 2023

Eur J Nucl Med Mol Imaging

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Purpose To investigate the prognostic value of [18F]FDG PET/CT as part of response monitoring in metastatic melanoma patients treated with immune checkpoint inhibitors (ICIs). Methods Sixty-seven patients underwent [18F]FDG PET/CT before start of treatment (baseline PET/CT), after two cycles (interim PET/CT) and after four cycles of ICIs administration (late PET/CT). Metabolic response evaluation was based on the conventional EORTC and PERCIST criteria, as well as the newly introduced, immunotherapy-modified PERCIMT, imPERCIST5 and iPERCIST criteria. Metabolic response to immunotherapy was classified according to four response groups (complete metabolic response [CMR], partial metabolic response [PMR], stable metabolic disease [SMD], progressive metabolic disease [PMD]), and further dichotomized by response rate (responders = [CMR] + [PMR] vs. non-responders = [PMD] + [SMD]), and disease control rate (disease control = [CMR] + [PMR] + [SMD] vs. [PMD]). The spleen-to-liver SUV ratios (SLRmean, SLRmax) and bone marrow-to-liver SUV ratios (BLRmean, BLRmax) were also calculated. The results of PET/CT were correlated with patients’ overall survival (OS). Results Median patient follow up [95% CI] was 61.5 months [45.3 – 66.7 months]. On interim PET/CT, the application of the novel PERCIMT demonstrated significantly longer survival for metabolic responders, while the rest criteria revealed no significant survival differences between the different response groups. Respectively on late PET/CT, both a trend for longer OS and significantly longer OS were observed in patients responding to ICIs with metabolic response and disease control after application of various criteria, both conventional and immunotherapy-modified. Moreover, patients with lower SLRmean values demonstrated significantly longer OS. Conclusion In patients with metastatic melanoma PET/CT-based response assessment after four ICIs cycles is significantly associated with OS after application of different metabolic criteria. The prognostic performance of the modality is also high after the first two ICIs cycles, especially with employment of novel criteria. In addition, investigation of spleen glucose metabolism may provide further prognostic information.

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Section: Discussionsupporting

confidence: 86%

The prognostic value of [18F]FDG PET/CT based response monitoring in metastatic melanoma patients undergoing immunotherapy: comparison of different metabolic criteria

Sachpekidis

Weru

Kopp‐Schneider

et al. 2023

Eur J Nucl Med Mol Imaging

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“…Therefore, as proposed by PET Response Evaluation Criteria for Immunotherapy (PERCIMT) and Immunotherapy-modified PET Response Criteria in Solid Tumors (imPERCIST) criteria, respectively, according to their number and size, new lesions may be considered a sign of progression if the metabolic activity is greater than a predetermined cut-off [ 260 ]. A relatively recent study by Rivas et al showed that the evaluation of ICI responses using metabolic imaging with imPERCIST5 and PERCIST5 (criteria used for conventional chemotherapy) was significantly associated with overall survival in 29 patients with advanced or metastatic cutaneous melanoma [ 261 ]. Among the many variants of SUV (e.g., mean SUV, maximum SUV), SUV corrected for lean body mass (SUL) was chosen for use with PERCIST because it is less susceptible to variations in patient body weight than the other SUV metrics [ 262 ].…”

Section: Molecular Imaging Techniquesmentioning

confidence: 99%

Skin Cancer Pathobiology at a Glance: A Focus on Imaging Techniques and Their Potential for Improved Diagnosis and Surveillance in Clinical Cohorts

Dobre

Surcel

Constantin

et al. 2023

IJMS

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Early diagnosis is essential for completely eradicating skin cancer and maximizing patients’ clinical benefits. Emerging optical imaging modalities such as reflectance confocal microscopy (RCM), optical coherence tomography (OCT), magnetic resonance imaging (MRI), near-infrared (NIR) bioimaging, positron emission tomography (PET), and their combinations provide non-invasive imaging data that may help in the early detection of cutaneous tumors and surgical planning. Hence, they seem appropriate for observing dynamic processes such as blood flow, immune cell activation, and tumor energy metabolism, which may be relevant for disease evolution. This review discusses the latest technological and methodological advances in imaging techniques that may be applied for skin cancer detection and monitoring. In the first instance, we will describe the principle and prospective clinical applications of the most commonly used imaging techniques, highlighting the challenges and opportunities of their implementation in the clinical setting. We will also highlight how imaging techniques may complement the molecular and histological approaches in sharpening the non-invasive skin characterization, laying the ground for more personalized approaches in skin cancer patients.

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“…Risk stratification before treatment initiation is therefore of great interest for personalized treatment decisions. Noninvasive imaging techniques enable the quantitative assessment of the individual tumor burden on the molecular level (by 8F-labeled fluorodeoxyglucose positron-emission tomography (18F-FDG-PET)), as well as on the morphological and functional levels (by multiparametric MRI), including diffusion-weighted imaging (DWI) [ 6 ]. For CIT, previous studies indicated a possibly predictive value of the metabolic activity of the primary and secondary lymphoid organs in 18F-FDG-PET [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Development of a Hybrid-Imaging-Based Prognostic Index for Metastasized-Melanoma Patients in Whole-Body 18F-FDG PET/CT and PET/MRI Data

Küstner¹,

Vogel²,

Hepp³

et al. 2022

Diagnostics

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Besides tremendous treatment success in advanced melanoma patients, the rapid development of oncologic treatment options comes with increasingly high costs and can cause severe life-threatening side effects. For this purpose, predictive baseline biomarkers are becoming increasingly important for risk stratification and personalized treatment planning. Thus, the aim of this pilot study was the development of a prognostic tool for the risk stratification of the treatment response and mortality based on PET/MRI and PET/CT, including a convolutional neural network (CNN) for metastasized-melanoma patients before systemic-treatment initiation. The evaluation was based on 37 patients (19 f, 62 ± 13 y/o) with unresectable metastasized melanomas who underwent whole-body 18F-FDG PET/MRI and PET/CT scans on the same day before the initiation of therapy with checkpoint inhibitors and/or BRAF/MEK inhibitors. The overall survival (OS), therapy response, metastatically involved organs, number of lesions, total lesion glycolysis, total metabolic tumor volume (TMTV), peak standardized uptake value (SULpeak), diameter (Dmlesion) and mean apparent diffusion coefficient (ADCmean) were assessed. For each marker, a Kaplan–Meier analysis and the statistical significance (Wilcoxon test, paired t-test and Bonferroni correction) were assessed. Patients were divided into high- and low-risk groups depending on the OS and treatment response. The CNN segmentation and prediction utilized multimodality imaging data for a complementary in-depth risk analysis per patient. The following parameters correlated with longer OS: a TMTV < 50 mL; no metastases in the brain, bone, liver, spleen or pleura; ≤4 affected organ regions; no metastases; a Dmlesion > 37 mm or SULpeak < 1.3; a range of the ADCmean < 600 mm2/s. However, none of the parameters correlated significantly with the stratification of the patients into the high- or low-risk groups. For the CNN, the sensitivity, specificity, PPV and accuracy were 92%, 96%, 92% and 95%, respectively. Imaging biomarkers such as the metastatic involvement of specific organs, a high tumor burden, the presence of at least one large lesion or a high range of intermetastatic diffusivity were negative predictors for the OS, but the identification of high-risk patients was not feasible with the handcrafted parameters. In contrast, the proposed CNN supplied risk stratification with high specificity and sensitivity.

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18FDG PET Assessment of Therapeutic Response in Patients with Advanced or Metastatic Melanoma Treated with First-Line Immune Checkpoint Inhibitors

Cited by 5 publications

References 33 publications

The prognostic value of [18F]FDG PET/CT based response monitoring in metastatic melanoma patients undergoing immunotherapy: comparison of different metabolic criteria

The prognostic value of [18F]FDG PET/CT based response monitoring in metastatic melanoma patients undergoing immunotherapy: comparison of different metabolic criteria

Skin Cancer Pathobiology at a Glance: A Focus on Imaging Techniques and Their Potential for Improved Diagnosis and Surveillance in Clinical Cohorts

Development of a Hybrid-Imaging-Based Prognostic Index for Metastasized-Melanoma Patients in Whole-Body 18F-FDG PET/CT and PET/MRI Data

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