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Predictive value and accuracy of [(18)F]FDG PET/CT modified response criteria for checkpoint immunotherapy in patients with advanced melanoma

PURPOSE: Immune checkpoint inhibitors (ICIs) are widely used in metastatic melanoma and dramatically alter the treatment of these patients. Given the high cost and potential toxicity, a reliable method for evaluating treatment response is needed. In this study, we assessed tumor response in patients...

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Autores principales: Ayati, Narjess, Jamshidi-Araghi, Zahra, Hoellwerth, Magdalena, Schweighofer-Zwink, Gregor, Hitzl, Wolfgang, Koelblinger, Peter, Pirich, Christian, Beheshti, Mohsen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317870/
https://www.ncbi.nlm.nih.gov/pubmed/37140669
http://dx.doi.org/10.1007/s00259-023-06247-8
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author Ayati, Narjess
Jamshidi-Araghi, Zahra
Hoellwerth, Magdalena
Schweighofer-Zwink, Gregor
Hitzl, Wolfgang
Koelblinger, Peter
Pirich, Christian
Beheshti, Mohsen
author_facet Ayati, Narjess
Jamshidi-Araghi, Zahra
Hoellwerth, Magdalena
Schweighofer-Zwink, Gregor
Hitzl, Wolfgang
Koelblinger, Peter
Pirich, Christian
Beheshti, Mohsen
author_sort Ayati, Narjess
collection PubMed
description PURPOSE: Immune checkpoint inhibitors (ICIs) are widely used in metastatic melanoma and dramatically alter the treatment of these patients. Given the high cost and potential toxicity, a reliable method for evaluating treatment response is needed. In this study, we assessed tumor response in patients with metastatic melanoma treated with ICIs using three modified response criteria: PET Response Evaluation Criteria for Immunotherapy (PERCIMT), PET Response Criteria in Solid Tumors for up to Five Lesions (PERCIST5), and immunotherapy-modified PET Response Criteria in Solid Tumors for up to Five Lesions (imPERCIST5). METHODS: Ninety-one patients with non-resectable stage IV metastatic melanoma who received ICIs were retrospectively enrolled in this study. Each patient had two [(18)F]FDG PET/CT scans performed before and after ICI therapy. Responses at the follow-up scan were evaluated according to PERCIMT, PERCIST5, and imPERCIST5 criteria. Patients were classified into four groups: complete metabolic response (CMR), partial metabolic response (PMR), progressive metabolic disease (PMD), and stable metabolic disease (SMD). To assess the “disease control rate,” two groups have been defined based on each criterion: patients with CMR, PMR, and SMD as “disease-controlled group (i.e., responders)” and PMD as the “uncontrolled-disease group (i.e., non-responders)”. The correspondence between metabolic tumor response defined by these criteria and clinical outcome was assessed and compared. RESULTS: The response and the disease control rates were 40.7% and 71.4%, 41.8% and 50.5%, and 54.9% and 74.7% based on the PERCIMT, PERCIST5, and imPERCIST5 criteria, respectively. PERCIMT and imPERCIST5 showed significantly different disease control rates from that of PERCIST5 (P < 0.001), whereas it was not significant between PERCIMT and imPERCIST5. Overall survival was significantly longer in the metabolic responder groups than in the non-responder groups based on PERCIMT and PERCIST5 criteria (PERCIMT: 2.48 versus 1.47 years, P = 0.003; PERCIST5: 2.57 versus 1.81 years. P = 0.017). However, according to imPERCIST5 criterion, this difference was not observed (P = 0.12). CONCLUSION: Although the appearance of new lesions can be secondary to an inflammatory response to ICIs and indicative of pseudoprogression, given the higher rate of true progression, the appearance of new lesions should be interpreted deliberately. Of the three assessed modified criteria, PERCIMT appear to provide more reliable metabolic response assessment that correlates strongly with overall patient survival. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00259-023-06247-8.
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spelling pubmed-103178702023-07-05 Predictive value and accuracy of [(18)F]FDG PET/CT modified response criteria for checkpoint immunotherapy in patients with advanced melanoma Ayati, Narjess Jamshidi-Araghi, Zahra Hoellwerth, Magdalena Schweighofer-Zwink, Gregor Hitzl, Wolfgang Koelblinger, Peter Pirich, Christian Beheshti, Mohsen Eur J Nucl Med Mol Imaging Original Article PURPOSE: Immune checkpoint inhibitors (ICIs) are widely used in metastatic melanoma and dramatically alter the treatment of these patients. Given the high cost and potential toxicity, a reliable method for evaluating treatment response is needed. In this study, we assessed tumor response in patients with metastatic melanoma treated with ICIs using three modified response criteria: PET Response Evaluation Criteria for Immunotherapy (PERCIMT), PET Response Criteria in Solid Tumors for up to Five Lesions (PERCIST5), and immunotherapy-modified PET Response Criteria in Solid Tumors for up to Five Lesions (imPERCIST5). METHODS: Ninety-one patients with non-resectable stage IV metastatic melanoma who received ICIs were retrospectively enrolled in this study. Each patient had two [(18)F]FDG PET/CT scans performed before and after ICI therapy. Responses at the follow-up scan were evaluated according to PERCIMT, PERCIST5, and imPERCIST5 criteria. Patients were classified into four groups: complete metabolic response (CMR), partial metabolic response (PMR), progressive metabolic disease (PMD), and stable metabolic disease (SMD). To assess the “disease control rate,” two groups have been defined based on each criterion: patients with CMR, PMR, and SMD as “disease-controlled group (i.e., responders)” and PMD as the “uncontrolled-disease group (i.e., non-responders)”. The correspondence between metabolic tumor response defined by these criteria and clinical outcome was assessed and compared. RESULTS: The response and the disease control rates were 40.7% and 71.4%, 41.8% and 50.5%, and 54.9% and 74.7% based on the PERCIMT, PERCIST5, and imPERCIST5 criteria, respectively. PERCIMT and imPERCIST5 showed significantly different disease control rates from that of PERCIST5 (P < 0.001), whereas it was not significant between PERCIMT and imPERCIST5. Overall survival was significantly longer in the metabolic responder groups than in the non-responder groups based on PERCIMT and PERCIST5 criteria (PERCIMT: 2.48 versus 1.47 years, P = 0.003; PERCIST5: 2.57 versus 1.81 years. P = 0.017). However, according to imPERCIST5 criterion, this difference was not observed (P = 0.12). CONCLUSION: Although the appearance of new lesions can be secondary to an inflammatory response to ICIs and indicative of pseudoprogression, given the higher rate of true progression, the appearance of new lesions should be interpreted deliberately. Of the three assessed modified criteria, PERCIMT appear to provide more reliable metabolic response assessment that correlates strongly with overall patient survival. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00259-023-06247-8. Springer Berlin Heidelberg 2023-05-04 2023 /pmc/articles/PMC10317870/ /pubmed/37140669 http://dx.doi.org/10.1007/s00259-023-06247-8 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Ayati, Narjess
Jamshidi-Araghi, Zahra
Hoellwerth, Magdalena
Schweighofer-Zwink, Gregor
Hitzl, Wolfgang
Koelblinger, Peter
Pirich, Christian
Beheshti, Mohsen
Predictive value and accuracy of [(18)F]FDG PET/CT modified response criteria for checkpoint immunotherapy in patients with advanced melanoma
title Predictive value and accuracy of [(18)F]FDG PET/CT modified response criteria for checkpoint immunotherapy in patients with advanced melanoma
title_full Predictive value and accuracy of [(18)F]FDG PET/CT modified response criteria for checkpoint immunotherapy in patients with advanced melanoma
title_fullStr Predictive value and accuracy of [(18)F]FDG PET/CT modified response criteria for checkpoint immunotherapy in patients with advanced melanoma
title_full_unstemmed Predictive value and accuracy of [(18)F]FDG PET/CT modified response criteria for checkpoint immunotherapy in patients with advanced melanoma
title_short Predictive value and accuracy of [(18)F]FDG PET/CT modified response criteria for checkpoint immunotherapy in patients with advanced melanoma
title_sort predictive value and accuracy of [(18)f]fdg pet/ct modified response criteria for checkpoint immunotherapy in patients with advanced melanoma
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317870/
https://www.ncbi.nlm.nih.gov/pubmed/37140669
http://dx.doi.org/10.1007/s00259-023-06247-8
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