Baseline total metabolic tumour volume on 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography-computed tomography as a promising biomarker in patients with advanced non–small cell lung cancer treated with first-line pembrolizumab

• DOI: 10.1016/j.ejca.2021.03.020
• Publication Date: 2021-04-21T07:20:50Z
• Authors: Filippo G. Dall’Olio; Diletta Calabrò; Nicole Conci; Giulia Argalia; Paola Valeria Mar...; Francesca Fabbri; Benedetta Fragomeno; Dalia Ricci; Stefano Fanti; Valentina Ambrosini; Andrea Ardizzoni
• Keywords: Male; Lung Neoplasms; Clinical Decision-Making; Antibodies, Monoclonal, Humanized; Tumor Burden; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Fluorodeoxyglucose F18; Predictive Value of Tests; Carcinoma, Non-Small-Cell Lung; Positron Emission Tomography Computed Tomography; Humans; Advanced cancer; Biomarker; Immune checkpoint inhibitors; Lung cancer; MTV; NSCLC; PD-L1; Predictive; Prognostic; Total metabolic tumour volume; [18F]FDG PET/CT; Aged; Antibodies, Monoclonal, Humanized; Carcinoma, Non-Small-Cell Lung; Clinical Decision-Making; Female; Humans; Immune Checkpoint Inhibitors; Lung Neoplasms; Male; Neoplasm Staging; Predictive Value of Tests; Retrospective Studies; Treatment Outcome; Tumor Burden; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Female; Radiopharmaceuticals; Immune Checkpoint Inhibitors; Aged; Neoplasm Staging; Retrospective Studies

Immune checkpoint inhibitors (ICIs) have become the standard of care in the management of advanced non-small cell lung cancer (NSCLC). Nevertheless, only a small proportion of patients benefit from ICIs. The aim of the present study is to assess whether 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography-computed tomography ([18F]FDG-PET/CT)-derived parameters may be used as biomarkers in patients with advanced NSCLC receiving first-line pembrolizumab.This is a monocentric retrospective cohort study including patients with advanced NSCLC (stage IV) and Programmed death-ligand 1 (PD-L1) expression ≥50% treated with pembrolizumab. A control group of patients treated with epidermal growth factor receptor (EGFR) inhibitors for EGFR-mutated NSCLC was also enrolled. Only patients with a positive [18F]18F-FDG PET/CT result within 60 days from treatment initiation were included.Total metabolic tumour volume (tMTV) was calculated for each lesion using a dedicated software (PET VCAR; GE Healthcare), which semiautomatically delineates the tumour's contours with a maximum standardised uptake value (SUVmax) threshold of 42% within the lesion. tMTV was obtained summing each lesion's MTV. Potential prognostic parameters for overall survival (OS) were analysed (tMTV, SUVmax, bone/liver metastasis, neutrophil:lymphocyte ratio ≥4, Eastern Cooperative Oncology Group performance status ≥2, lactate dehydrogenase above the upper limit of normal).Overall, 34 patients treated with first line-pembrolizumab and 40 patients treated with EGFR tyrosine kinase inhibitors were included. In the pembrolizumab group, the median follow-up was 20.3, while the median OS was 4.7 months (95% confidence interval [CI] = 0.3-9.1) for patients with tMTV ≥75 cm3 vs not reached (NR) for patients with tMTV <75 cm3 (95% CI = NR-NR; hazard ratio [HR] = 5.37; 95% CI = 1.72-16.77; p = 0.004). No difference was found in the control group (HR = 1.43; 95% CI = 0.61-3.34; p = 0.411).Our data suggest that tMTV ≥75cm3 can be used as a prognostic biomarker of poor outcomes in patients with PD-L1-high advanced NSCLC treated with first-line pembrolizumab. This information could be useful for the selection of patients who may require the addition of chemotherapy to pembrolizumab.