Molecular Response Assessment with Immune Adaptive PERCIST in Lung Cancer Patients Treated with Nivolumab: Is It Better Than iRECIST?

Abstract

Aims We compared the immune response evaluation criteria in solid tumors (iRECIST) with immune adaptive positron emission tomography response criteria in solid tumors (imPERCIST) in lung cancer patients treated with nivolumab.

Materials and Methods Twenty lung cancer patients underwent fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan at baseline (PET-0), after four cycles (PET-1) and six to eight cycles (PET-2) of nivolumab were included. Kappa coefficient (k) was derived to see the level of agreement in two response criteria. Progression-free survival (PFS) curves were computed by the Kaplan–Meier method and compared with the Log Rank test. Univariate and multivariate regression for the percentage change in the sum of diameters (SoD), standard uptake value maximum (SUVmax), sum of metabolic tumor volume (SoMTV), and sum of total lesion glycolysis (SoTLG) was computed. A p-value less than 0.05 was considered significant.

Results Kappa coefficient showed a substantial level of agreement (k 0.769) in two response criteria. Mean PFS in partial response, stable disease, and progressive disease (PD) patients in iRECIST and imPERCIST was 27.3, 17.7, 4.2, and 23.3, 18.8, 3.8 months, respectively. The Kaplan–Meier method with the log rank test showed a significant difference in PFS on intracomparison within both criteria; however, it was not significant on intercomparison. On univariate analysis, the percentage change in SoD, SoMTV, SoTLG was significant. However, on multivariate analysis, only percentage change in SoD was a significant predictor.

Conclusions We concluded that imPERCIST was equally effective as currently recommended criteria iRECIST for response evaluation of nivolumab in lung cancer patients.

Keywords

immune checkpoint inhibitors - nivolumab - lung carcinoma - iRECIST - imPERCIST - progression-free survival

Publikationsverlauf

Artikel online veröffentlicht:
09. März 2022

• References

• 1 Eisenhauer EA, Therasse P, Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45 (02) 228-247
• 2 Choi H, Charnsangavej C, de Castro Faria S. et al. CT evaluation of the response of gastrointestinal stromal tumors after imatinib mesylate treatment: a quantitative analysis correlated with FDG PET findings. AJR Am J Roentgenol 2004; 183 (06) 1619-1628
• 3 Borcoman E, Nandikolla A, Long G, Goel S, Le Tourneau C. Patterns of response and progression to immunotherapy. Am Soc Clin Oncol Educ Book 2018; 38: 169-178
• 4 Wolchok JD, Hoos A, O'Day S. et al. Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria. Clin Cancer Res 2009; 15 (23) 7412-7420
• 5 Nishino M, Giobbie-Hurder A, Gargano M, Suda M, Ramaiya NH, Hodi FS. Developing a common language for tumor response to immunotherapy: immune-related response criteria using unidimensional measurements. Clin Cancer Res 2013; 19 (14) 3936-3943
• 6 Seymour L, Bogaerts J, Perrone A. et al; RECIST working group. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics. Lancet Oncol 2017; 18 (03) e143-e152
• 7 Hodi FS, Ballinger M, Lyons B. et al. Immune-modified response evaluation criteria in solid tumors (imRECIST): refining guidelines to assess the clinical benefit of cancer immunotherapy. J Clin Oncol 2018; 36 (09) 850-858
• 8 Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 2009; 50 (Suppl. 01) 122S-150S
• 9 O JH, Lodge MA, Wahl RL. O JH. Practical PERCIST: a simplified guide to PET response criteria in solid tumors 1.0. Radiology 2016; 280 (02) 576-584
• 10 Pinker K, Riedl C, Weber WA. Evaluating tumor response with FDG PET: updates on PERCIST, comparison with EORTC criteria and clues to future developments. Eur J Nucl Med Mol Imaging 2017; 44 (Suppl. 01) 55-66
• 11 Ding Q, Cheng X, Yang L. et al. PET/CT evaluation of response to chemotherapy in non-small cell lung cancer: PET response criteria in solid tumors (PERCIST) versus response evaluation criteria in solid tumors (RECIST). J Thorac Dis 2014; 6 (06) 677-683
• 12 Zhang H, Wroblewski K, Liao S. et al. Prognostic value of metabolic tumor burden from (18)F-FDG PET in surgical patients with non-small-cell lung cancer. Acad Radiol 2013; 20 (01) 32-40
• 13 Aide N, Hicks RJ, Le Tourneau C, Lheureux S, Fanti S, Lopci E. FDG PET/CT for assessing tumour response to immunotherapy: Report on the EANM symposium on immune modulation and recent review of the literature. Eur J Nucl Med Mol Imaging 2019; 46 (01) 238-250
• 14 Boellaard R, Delgado-Bolton R, Oyen WJ. et al; European Association of Nuclear Medicine (EANM). FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 2015; 42 (02) 328-354
• 15 Li Y, Zschaeck S, Lin Q, Chen S, Chen L, Wu H. Metabolic parameters of sequential 18F-FDG PET/CT predict overall survival of esophageal cancer patients treated with (chemo-) radiation. Radiat Oncol 2019; 14 (01) 35
• 16 Chun YJ, Jeung HC, Park HS. et al. Significance of metabolic tumor volume and total lesion glycolysis measured using ¹⁸F-FDG PET/CT in locally advanced and metastatic gallbladder carcinoma. Yonsei Med J 2019; 60 (07) 604-610
• 17 Castro NP, Osório CA, Torres C. et al. Evidence that molecular changes in cells occur before morphological alterations during the progression of breast ductal carcinoma. Breast Cancer Res 2008; 10 (05) R87
• 18 Goldfarb L, Duchemann B, Chouahnia K, Zelek L, Soussan M. Monitoring anti-PD-1-based immunotherapy in non-small cell lung cancer with FDG PET: introduction of iPERCIST. EJNMMI Res 2019; 9 (01) 8
• 19 El-Galaly TC, Villa D, Gormsen LC, Baech J, Lo A, Cheah CY. FDG-PET/CT in the management of lymphomas: current status and future directions. J Intern Med 2018; 284 (04) 358-376
• 20 Cho SY, Lipson EJ, Im HJ. et al. Prediction of response to immune checkpoint inhibitor therapy using early time-point (18)F-FDG PET/CT imaging in patients with advanced melanoma. J Nucl Med 2017; 58 (09) 1421-1428
• 21 Kaira K, Higuchi T, Naruse I. et al. Metabolic activity by ¹⁸F-FDG-PET/CT is predictive of early response after nivolumab in previously treated NSCLC. Eur J Nucl Med Mol Imaging 2018; 45 (01) 56-66
• 22 Rossi G, Bauckneht M, Genova C. et al. Comparison between 18F-FDG-PET- and CT-based criteria in non-small cell lung cancer (NSCLC) patients treated with Nivolumab. J Nucl Med 2019
• 23 Anwar H, Sachpekidis C, Winkler J. et al. Absolute number of new lesions on ¹⁸F-FDG PET/CT is more predictive of clinical response than SUV changes in metastatic melanoma patients receiving ipilimumab. Eur J Nucl Med Mol Imaging 2018; 45 (03) 376-383