FLT-PET At 6 Weeks Predicts Response Assessed by CT at 12 Weeks in Melanoma Patients Treated With Pembrolizumab.

Abstract:

PURPOSE:Investigate the ability of F-fluorothymidine (FLT) PET combined with CT at 6 weeks to predict treatment response at 12 weeks after treatment with pembrolizumab. METHODS:Five patients with unresectable stage IV melanoma were included in this single-institution pilot study. Patients underwent FLT-PET/CT (baseline and 6 weeks) and CT (baseline and 12 weeks). FLT-PET/CT response and CT response were assessed using PET Response Criteria in Solid Tumors and immune Response Evaluation Criteria in Solid Tumors, respectively. Patients were categorized as responders (complete response, partial response) and nonresponders (stable disease, progressive disease). Agreement between 6-week FLT-PET/CT and 12-week CT was calculated using Cohen kappa's agreement. Eight baseline FLT-PET/CT parameters were extracted: SUVmax, SUVpeak, SUVSD, SUVmean, proliferative tumor volume, total lesion proliferation, bone marrow-to-liver SUVmax ratio, and spleen-to-liver SUVmax ratio. Eight delta-parameters were extracted at 6 weeks by calculating variation in FLT uptake as percentage change from baseline. RESULTS:Agreement between 6-week FLT-PET/CT and 12-week CT was kappa = 0.615, P = 0.025. Three of 5 patients were categorized as responders on CT by immune Response Evaluation Criteria in Solid Tumors. At baseline, responders had a lower mean proliferative tumor volume and a higher bone marrow-to-liver SUVmax ratio. At 6 weeks, responders demonstrated a decrease in tumor volume and tumor proliferation. CONCLUSIONS:Our study illustrates the potential for FLT-PET/CT as an early predictor of response for patients with metastatic melanoma on anti-PD1 immunotherapy. Larger studies are indicated to confirm these findings.

journal_name

Clin Nucl Med

authors

Yeh R,Trager MH,Rizk EM,Finkel GG,Barker LW,Carvajal RD,Geskin LJ,Schwartz GK,Schwartz L,Dercle L,Saenger YM

doi

10.1097/RLU.0000000000002967

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

267-275

issue

4

eissn

0363-9762

issn

1536-0229

journal_volume

45

pub_type

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