¹⁸F-FDG PET/CT Can Predict Development of Thyroiditis Due to Immunotherapy for Lung Cancer

Abstract

Our primary purpose was to determine whether increased F-FDG uptake in the thyroid gland predicts development of thyroiditis with subsequent hypothyroidism in patients undergoing immunotherapy with nivolumab for lung cancer. Secondarily, we determined whetherF-FDG uptake in the thyroid gland correlates with number of administered cycles of nivolumab. Retrospective chart review over 2 y found 18 lung cancer patients treated with nivolumab who underwentF-FDG PET/CT before and during therapy. SUV, SUV, and total lesion glycolysis of the thyroid gland were measured. SUVs were also measured for the pituitary gland, liver, and spleen. Patients underwent monthly thyroid testing. PET/CT parameters were analyzed by unpaired testing for differences between 2 groups (patients who developed hypothyroidism and those who did not). Correlation between development of thyroiditis and number of cycles of nivolumab was also tested. Six of 18 patients developed hypothyroidism. The test comparing the 2 groups demonstrated significant differences in SUV ( = 0.04), SUV ( = 0.04), and total lesion glycolysis ( = 0.02) of the thyroid gland. Two of 4 patients who developed thyroiditis and had increased F-FDG uptake in the thyroid gland had a normal TSH level at the time of follow-upF-FDG PET/CT. Patients who developed thyroiditis with subsequent hypothyroidism stayed longer on therapy (10.6 cycles) than patients without thyroiditis (7.6 cycles), but the trend was not statistically significant. No significant difference in PET/CT parameters was observed for pituitary gland, liver, or spleen. F-FDG PET/CT can predict the development of thyroiditis with subsequent hypothyroidism before laboratory testing. Further study is required to confirm the positive trend between thyroiditis and duration of therapy.

Management of endocrine immune-related adverse events of immune checkpoint inhibitors: an updated review

“…Patients with increased 18 FDG uptake in the thyroid before ICI-treatment could have an increased risk for developing/worsening TDs ( 61 ). Higher 18 FDG uptake could be correlated with the severity of hypothyroidism and TgAb positivity ( 63 ) and might predict the development of thyroiditis with subsequent hypothyroidism ( 83 ).…”

NSCLC Biomarkers to Predict Response to Immunotherapy with Checkpoint Inhibitors (ICI): From the Cells to In Vivo Images

“…In NSCLC patients, the most common irAEs are rash and diarrhea with nivolumab treatment and hypo-and hyperthyroidism with pembrolizumab treatment [153]. In particular, thyroiditis has an incidence of 5-23%, and [18F]FDG uptake in the thyroid gland can depict thyroid inflammation even before laboratory changes are observed and allows the prediction of thyroid dysfunction development, as demonstrated by the study by Eshgh et al [154], which was performed on 18 patients with NSCL and who were treated with nivolumab. Interestingly, it has been recently shown that the onset of irAEs may also predict the clinic benefit of ICIs [155][156][157].…”

NSCLC Biomarkers to Predict Response to Immunotherapy with Checkpoint Inhibitors (ICI): From the Cells to in-Vivo Images

“…In NSCLC patients, the most common irAEs are rash and diarrhea with nivolumab treatment and hypo-and hyperthyroidism with pembrolizumab treatment [141]. In particular, thyroiditis has an incidence of 5%-23% and [18F]FDG uptake in the thyroid gland can depict thyroid inflammation even before laboratory changes are observed and allows prediction of development of thyroid dysfunction, as demonstrated by the study of Eshgh et al [142], performed on 18 patients with NSCL and treated with nivolumab. Interestingly , it has been recently shown that the onset of irAEs may also predict ICIs clinical benefit [143][144][145].…”