Outcome prediction based on [18F]FDG PET/CT in patients with pleural mesothelioma treated with ipilimumab and nivolumab +/- UV1 telomerase vaccine.

IF 8.6 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING European Journal of Nuclear Medicine and Molecular Imaging Pub Date : 2024-08-12 DOI:10.1007/s00259-024-06853-0

Solfrid Thunold, Eivor Hernes, Saima Farooqi, Åsa Kristina Öjlert, Roslyn J Francis, Anna K Nowak, Weronika Maria Szejniuk, Søren Steen Nielsen, Susana Cedres, Marc Simo Perdigo, Jens Benn Sørensen, Carin Meltzer, Lars Tore Gyland Mikalsen, Åslaug Helland, Eirik Malinen, Vilde Drageset Haakensen

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Abstract

Purpose: The introduction of immunotherapy in pleural mesothelioma (PM) has highlighted the need for effective outcome predictors. This study explores the role of [18F]FDG PET/CT in predicting outcomes in PM treated with immunotherapy.

Methods: Patients from the NIPU trial, receiving ipilimumab and nivolumab +/- telomerase vaccine in second-line, were included. [18F]FDG PET/CT was obtained at baseline (n = 100) and at week-5 (n = 76). Metabolic tumour volume (MTV) and peak standardised uptake value (SUV_peak) were evaluated in relation to survival outcomes. Wilcoxon rank-sum test was used to assess differences in MTV, total lesion glycolysis (TLG), maximum standardised uptake value (SUV_max) and SUV_peak between patients exhibiting an objective response, defined as either partial response or complete response according to the modified Response Criteria in Solid Tumours (mRECIST) and immune RECIST (iRECIST), and non-responders, defined as either stable disease or progressive disease as their best overall response.

Results: Univariate Cox regression revealed significant associations of MTV with OS (HR 1.36, CI: 1.14, 1.62, p < 0.001) and PFS (HR 1.18, CI: 1.03, 1.34, p = 0.02), while multivariate analysis showed a significant association with OS only (HR 1.35, CI: 1.09, 1.68, p = 0.007). While SUV_peak was not significantly associated with OS or PFS in univariate analyses, it was significantly associated with OS in multivariate analysis (HR 0.43, CI: 0.23, 0.80, p = 0.008). Objective responders had significant reductions in TLG, SUV_max and SUV_peak at week-5.

Conclusion: MTV provides prognostic value in PM treated with immunotherapy. High SUV_peak was not associated with inferior outcomes, which could be attributed to the distinct mechanisms of immunotherapy. Early reductions in PET metrics correlated with treatment response.

Study registration: The NIPU trial (NCT04300244) is registered at clinicaltrials.gov. https://classic.

Clinicaltrials: gov/ct2/show/NCT04300244?cond=Pleural+Mesothelioma&cntry=NO&draw=2&rank=4.

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基于[18F]FDG PET/CT预测接受伊匹单抗和尼伐单抗+/-UV1端粒酶疫苗治疗的胸膜间皮瘤患者的预后。

目的：胸膜间皮瘤（PM）免疫疗法的引入凸显了对有效结果预测指标的需求。本研究探讨了[18F]FDG PET/CT在预测接受免疫疗法治疗的胸膜间皮瘤预后中的作用：方法：纳入NIPU试验中接受伊匹单抗和尼伐单抗+/-端粒酶疫苗二线治疗的患者。在基线（100人）和第5周（76人）时进行[18F]FDG PET/CT检查。评估了代谢肿瘤体积（MTV）和峰值标准化摄取值（SUVpeak）与生存结果的关系。采用Wilcoxon秩和检验来评估MTV、总病灶糖酵解（TLG）、最大标准化摄取值（SUVmax）和SUVpeak在客观反应患者（根据实体瘤改良反应标准（mRECIST）和免疫RECIST（iRECIST）定义为部分反应或完全反应）和非反应患者（根据最佳总体反应定义为疾病稳定或疾病进展）之间的差异：单变量Cox回归显示MTV与OS（HR 1.36，CI：1.14，1.62，p < 0.001）和PFS（HR 1.18，CI：1.03，1.34，p = 0.02）显著相关，而多变量分析仅显示MTV与OS显著相关（HR 1.35，CI：1.09，1.68，p = 0.007）。在单变量分析中，SUVpeak与OS或PFS无显著相关性，但在多变量分析中，SUVpeak与OS有显著相关性（HR 0.43，CI：0.23，0.80，P = 0.008）。客观应答者在第5周时TLG、SUVmax和SUVpeak均明显下降：结论：MTV对接受免疫疗法治疗的 PM具有预后价值。高SUVpeak与不良预后无关，这可能与免疫疗法的不同机制有关。PET指标的早期降低与治疗反应相关：NIPU试验（NCT04300244）已在clinicaltrials.gov注册。https://classic.Clinicaltrials: gov/ct2/show/NCT04300244?cond=Pleural+Mesothelioma&cntry=NO&draw=2&rank=4。

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来源期刊

European Journal of Nuclear Medicine and Molecular Imaging 医学-核医学

CiteScore

15.60

自引率

9.90%

发文量

392

审稿时长

3 months

期刊介绍： The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.