title: Prediction of Response to Immune Checkpoint Inhibitor Therapy Using Early-Time-Point18F-FDG PET/CT Imaging in Patients with Advanced Melanoma.
abstract: The purpose of this study was to evaluate18F-FDG PET/CT scanning as an early predictor of response to immune checkpoint inhibitors (ICIs) in patients with advanced melanoma.Methods:Twenty patients with advanced melanoma receiving ICI prospectively underwent18F-FDG PET/CT at 3 scan intervals: before treatment initiation (SCAN-1), at days 21-28 (SCAN-2), and at 4 mo (SCAN-3). This study was approved by the institutional review board, and informed consent was received from all patients who were enrolled between April 2012 and December 2013. Tumor response at each posttreatment time point was assessed according to RECIST 1.1, immune-related response criteria, PERCIST (PERCIST 1.0), and European Organization for Research and Treatment of Cancer (EORTC) criteria. Performance characteristics of each metric to predict best overall response (BOR) at ≥ 4 mo were assessed.Results:Twenty evaluable patients were treated with ipilimumab (n= 16), BMS-936559 (n= 3), or nivolumab (n= 1). BOR at ≥ 4 mo included complete response (n= 2), partial response (n= 2), stable disease (n= 1), and progressive disease (n= 15). Response evaluations at SCAN-2 using RECIST 1.1, immune-related response criteria, PERCIST, and EORTC criteria demonstrated accuracies of 75%, 70%, 70%, and 65%, respectively, to predict BOR at ≥ 4 mo. Interestingly, the optimal PERCIST and EORTC threshold values at SCAN-2 to predict BOR were >15.5% and >14.7%, respectively. By combining anatomic and functional imaging data collected at SCAN-2, we developed criteria to predict eventual response to ICI with 100% sensitivity, 93% specificity, and 95% accuracy.Conclusion:Combining functional and anatomic imaging parameters from18F-FDG PET/CT scans performed early in ICI appears predictive for eventual response in patients with advanced melanoma. These findings require validation in larger cohorts.
authors.affiliation: Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland scho@uwhealth.org.|University of Wisconsin School of Medicine and Public Health and Carbone Comprehensive Cancer Center, Madison, Wisconsin.
authors.forename: Steve Y
authors.initials: SY
authors.lastname: Cho
authors.affiliation: Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Lipson
authors.affiliation: University of Wisconsin School of Medicine and Public Health and Carbone Comprehensive Cancer Center, Madison, Wisconsin.|Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea; and.
authors.forename: Hyung-Jun
authors.initials: HJ
authors.lastname: Im
authors.affiliation: Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Rowe
authors.affiliation: Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Esther Mena
authors.initials: EM
authors.lastname: Gonzalez
authors.affiliation: Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Amanda
authors.initials: A
authors.lastname: Blackford
authors.affiliation: Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Alin
authors.initials: A
authors.lastname: Chirindel
authors.affiliation: Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Drew M
authors.initials: DM
authors.lastname: Pardoll
authors.affiliation: Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Topalian
authors.affiliation: Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.|Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Wahl
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D015398:Signal Transduction / Q000187:drug effects* / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: FDG; PET/CT; immune checkpoint inhibitor; melanoma; response assessment