Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia.
Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.
J Nucl Med. 2021 Jul 1;62(7):926-933. doi: 10.2967/jnumed.120.254508. Epub 2020 Nov 27.
Immunotherapy using programmed death-1 blockers is a promising modality for non-small cell lung cancer (NSCLC). Therefore, defining the most accurate response criteria for immunotherapy monitoring is of great importance in patient management. This study aimed to compare the correlation between survival outcome and response assessment by PERCIST, version 1.0; immunotherapy-modified PERCIST (imPERCIST); RECIST, version 1.1; and immunotherapy-modified RECIST (iRECIST) in NSCLC patients. Seventy-two patients with NSCLC who were treated with nivolumab or pembrolizumab and had baseline and follow-up F-FDG PET/CT data were analyzed. The patients were categorized into responders (complete or partial response) and nonresponders (stable or progressive disease) according to PERCIST1 and PERCIST5 (analyzing the peak SUV normalized by lean body mass [SUL] of 1 or up to 5 lesions), imPERCIST1, imPERCIST5, RECIST, and iRECIST. The correlation between achieved response and overall survival (OS) was compared. The overall response rate and the overall disease control rate of the study population were 29% and 74%, respectively. The OS and progression-free survival (PFS) of patients with complete and partial response were statistically comparable. The OS and PFS were significantly different between responders and nonresponders (20.3 vs. 10.6 mo, = 0.001, for OS and 15.5 vs. 2.2 mo, < 0.001, for PFS, respectively). Twenty-three (32%) patients with progressive disease according to PERCIST5 had controlled disease according to imPERCIST5; follow-up of patients showed that 22% of these patients had pseudoprogression. The overall incidence of pseudoprogression was 7%. The response rate was 25% and 24% according to PERCIST1 and PERCIST5 ( = 0.2) and 32% and 29% according to imPERCIST1 and imPERCIST5 ( = 0.5), respectively, indicating no significant difference between analyzing the SUL of only the most F-FDG-avid lesion and analyzing up to the 5 most F-FDG-avid lesions. The achieved response by all conventional and immunotherapy-modified methods correlated strongly with patients' survival outcome, with significantly longer OS and PFS in responders than in nonresponders according to all assessed definitions. The most F-FDG-avid lesion according to PERCIST and imPERCIST accurately reflects the overall metabolic response.
免疫疗法使用程序性死亡受体-1 阻断剂是治疗非小细胞肺癌(NSCLC)的一种有前途的方法。因此,在患者管理中,确定最准确的免疫疗法监测反应标准非常重要。本研究旨在比较 PERCIST 第 1.0 版、免疫疗法改良 PERCIST(imPERCIST)、RECIST 第 1.1 版和免疫疗法改良 RECIST(iRECIST)在 NSCLC 患者中的生存结局和反应评估之间的相关性。分析了 72 例接受纳武单抗或帕博利珠单抗治疗且基线和随访 F-FDG PET/CT 数据的 NSCLC 患者。根据 PERCIST1 和 PERCIST5(分析通过瘦体重标准化后的最大标准摄取值[SUL]的 1 个或最多 5 个病灶)、imPERCIST1、imPERCIST5、RECIST 和 iRECIST,将患者分为应答者(完全或部分缓解)和无应答者(稳定或进展性疾病)。比较了获得的反应与总生存期(OS)之间的相关性。研究人群的总体缓解率和总体疾病控制率分别为 29%和 74%。完全和部分缓解患者的 OS 和无进展生存期(PFS)无统计学差异。应答者和无应答者之间的 OS 和 PFS 差异有统计学意义(20.3 与 10.6 个月,OS ;15.5 与 2.2 个月,PFS ;均 )。根据 PERCIST5,23 例(32%)患者疾病进展,根据 imPERCIST5,疾病得到控制;随访患者显示,其中 22%的患者有假性进展。总体假性进展发生率为 7%。根据 PERCIST1 和 PERCIST5,缓解率分别为 25%和 24%( ),根据 imPERCIST1 和 imPERCIST5,缓解率分别为 32%和 29%( ),提示仅分析最 F-FDG 摄取病灶的 SUL 与分析最多 5 个最 F-FDG 摄取病灶之间无显著差异。所有常规和免疫疗法改良方法的获得反应与患者的生存结局密切相关,根据所有评估定义,应答者的 OS 和 PFS 明显长于无应答者。根据 PERCIST 和 imPERCIST,最 F-FDG 摄取的病灶准确反映了整体代谢反应。