Computed tomography texture analysis of response to second-line nivolumab in metastatic non-small cell lung cancer

OBJECTIVES: Assess computed tomography texture analysis of patients likely to benefit from nivolumab. MATERIALS & METHODS: Texture analysis was used to quantify heterogeneity within the largest tumor before immunotherapy. Histogram analysis was classified as hyperdense (positive skewness) or hypodense (negative skewness) and subclassified on median standard deviation value or entropy measurement. RESULTS: 47 patients were included. At a median follow-up of 18 months, statistical significant differences in progression-free survival were observed when stratified by positive skewness with low entropy, hazard ratio: 0.43 (0.19–0.95); p = 0.036, and positive skewness with low standard deviation, hazard ratio: 0.42 (0.18–0.96); p = 0.04. CONCLUSION: Patients who derive a clinical benefit to Nivolumab show a computed tomography texture of a hyperdense yet homogenous tumor.