Perspectives on joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards for [18F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors

Abstract

Response assessment in the context of immunomodulatory treatments represents a major challenge for the medical imaging community and requires a multidisciplinary approach with involvement of oncologists, radiologists, and nuclear medicine specialists. There is evolving evidence that [18F]FDG PET/CT is a useful diagnostic modality for this purpose. The clinical indications for, and the principal aspects of its standardization in this context have been detailed in the recently published “Joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards on recommended use of [18F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors version 1.0”. These recommendations arose from a fruitful collaboration between international nuclear medicine societies and experts in cancer treatment. In this perspective, the key elements of the initiative are reported, summarizing the core aspects of the guidelines for radiologists and nuclear medicine physicians. Beyond the previous guidelines, this perspective adds further commentary on how this technology can advance development of novel therapeutic approaches and guide management of individual patients.

Immunotherapy Response and Resistance in Patients with Advanced Uveal Melanoma

“…Further inclusion criteria included histologically con rmed metastases from UM and available radiological assessment with computer tomography (CT), magnetic resonance imaging (MRI) of the liver or 2-[ 18 F]-uorodeoxy-d-glucose whole-body positron emission tomography/computed tomography (FDG-PET/CT) at baseline (before treatment start) and after 12 weeks (+/-four weeks). In addition, the presence of at least one target lesion meeting the Response Criteria In Solid Tumors version 1.1 (RECISTv1.1) for CT and MRI [18] or immunotherapy-modi ed Positron Emission Tomography Response Criteria In Solid Tumors (imPERCIST5) for FDG-PET/CT [19,20] was required at baseline. Exclusion criteria were: non-evaluable disease at baseline and administration of concurrent liver-directed treatment between baseline and rst radiological assessment after treatment initiation.…”

“…If available, liver metastases were evaluated with a dedicated MRI of the liver. The treatment e cacy in CT or MRI was assessed using RECIST v1.1 [18], and the metabolic response in FDG-PET/CT was assessed with imPERCIST5 [19,20]. Response assessment by CT and MRI were classi ed as complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD).…”

Long axial field of view (LAFOV) PET-CT: implementation in static and dynamic oncological studies

“…Longitudinal PET studies will very likely gain acceptance and find their role both within routine therapy monitoring and also within clinical trials, given the fact that PET studies are more sensitive in evaluating short-term therapeutic effects compared to morphological imaging modalities [ 18 ]. Treatment stratification based on PET-CT is an important field in oncological management with promising results and significant therapeutic and prognostic implications in the entire spectrum of patient management, as recently highlighted in the field of immunotherapy [ 19 , 20 ].…”

Integrating [18F]-Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography with Radiation Therapy and Immunomodulation in Precision Therapy for Solid Tumors

“…The recently published joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards on [ 18 F]-FDG PET/CT use in immunomodulatory treatments [1] provide dedicated insight on how to perform, interpret, and report the scan during IO regimens [18,19].…”