Prognostic value of volumetric PET parameters at early response evaluation in melanoma patients treated with immunothera
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ORIGINAL ARTICLE
Prognostic value of volumetric PET parameters at early response evaluation in melanoma patients treated with immunotherapy Ryusuke Nakamoto 1 & Lisa C. Zaba 2 & Jarrett Rosenberg 1 & Sunil Arani Reddy 3 & Tomomi Watanabe Nobashi 4 & Guido Davidzon 1 & Carina Mari Aparici 1 & Judy Nguyen 1 & Farshad Moradi 1 & Andrei Iagaru 1 & Benjamin Lewis Franc 1 Received: 23 December 2019 / Accepted: 26 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The purpose of this study was to investigate the prognostic value of whole-body metabolic tumor volume (MTV) and other metabolic tumor parameters, obtained from baseline and first restaging 18F-FDG PET/CT scans in melanoma patients treated with immune checkpoint inhibitors (ICIs). Methods Eighty-five consecutive melanoma patients (M, 57; F, 28) treated with ICIs who underwent PET/CT scans before and approximately 3 months after the start of immunotherapy were retrospectively enrolled. Metabolic tumor parameters including MTV for all melanoma lesions were measured on each scan. A Cox proportional hazards model was used for univariate and multivariate analyses of metabolic parameters combined with known clinical prognostic factors associated with overall survival (OS). Kaplan–Meier curves for patients dichotomized based on median values of imaging parameters were generated. Results The median OS time in all patients was 45 months (95% CI 24–45 months). Univariate analysis demonstrated that MTV obtained from first restaging PET/CT scans (MTVpost) was the strongest prognostic factor for OS among PET/CT parameters (P < 0.0001). The median OS in patients with high MTVpost (≥ 23.44) was 16 months (95% CI 12–32 months) as compared with more than 60 months in patients with low MTVpost (< 23.44) (P = 0.0003). A multivariate model including PET/CT parameters and known clinical prognostic factors revealed that MTVpost and the presence of central nervous system lesions were independent prognostic factors for OS (P = 0.0004, 0.0167, respectively). One pseudoprogression case (1.2%) was seen in this population and classified into the high MTVpost group. Conclusion Whole-body metabolic tumor volume from PET scan acquired approximately 3 months following initiation of immunotherapy (MTVpost) is a strong prognostic indicator of OS in melanoma patients. Although the possibility of pseudoprogression must be considered whenever evaluating first restaging PET imaging, it only occurred in 1 patient in our cohort. Keywords PET/CT . 18F-FDG . Metabolic tumor volume . Melanoma . Immune checkpoint inhibitor . Immunotherapy
This article is part of the Topical Collection on Oncology - General Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00259-020-04792-0) contains supplementary material, which is available to authorized users. * Ryusuke Nakamoto [email protected] 1
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305
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