Immune-mediated Disease in Ipilimumab Immunotherapy of Melanoma with FDG PET-CT.
The purposes of this study were to provide a case-based overview of various immune-mediated side effects detected by 18F-Fluorodeoxyglucose (F-18 FDG) positron emission tomography-computed tomography (PET-CT) in the patients receiving ipilimumab immunotherapy for treatment of malignant melanoma, and discuss the importance of recognizing immune-mediated side effects in the use of F-18 FDG PET-CT for monitoring therapeutic effects of ipilimumab on metastatic melanoma.



This is a retrospective case series study of the patients diagnosed with melanoma who were subjected to immunomodulating therapy with ipilimumab. F-18 FDG PET-CT findings were reviewed, and the patients with immune-mediated side effects were selected for further analysis, in conjunction with review of clinical progress notes, the results of laboratory tests, and findings of other imaging tests.



Four patients with immune-mediated side effects were identified among the patients being treated with ipilimumab and subjected to F-18 FDG PET-CT for monitoring therapeutic effects. These immune mediated side effects include new findings of abnormal increased FDG uptake associated with immune-mediated pancreatitis and hypophysitis, as well as immune-mediated thyroiditis and colitis reported previously.



Various immune-mediated side effects were detected by F-18 FDG PET-CT in the patients subjected to immunomodulating therapy with ipilimumab. It is essential for the interpreting provider to recognize and differentiate abnormal FDG uptake associated with immune-mediated side effects from hypermetabolic malignant lesions when using F-18 FDG PET-CT for monitoring therapeutic effects of ipilimumab on melanoma lesions.
Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9140. Electronic address: Jason.Wachsmann@UTSouthwestern.edu.
Jason W
JW
Wachsmann
Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9140.
Ramapriya
R
Ganti
Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9140; Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.
Fangyu
F
Peng
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003092:Colitis / Q000139:chemically induced; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D000072659:Hypophysitis / Q000139:chemically induced; D007167:Immunotherapy / Q000009:adverse effects / Q000379:methods*; D000074324:Ipilimumab; D008297:Male; D008545:Melanoma / Q000188:drug therapy*; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D010195:Pancreatitis / Q000139:chemically induced; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy*; D013966:Thyroiditis / Q000139:chemically induced; D014057:Tomography, X-Ray Computed / Q000379:methods
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab; D019788:Fluorodeoxyglucose F18
FDG; PET-CT; immune-related adverse events; ipilimumab; melanoma