Schank Timo E, Forschner Andrea, Sachse Michael Max, Dimitrakopoulou-Strauss Antonia, Sachpekidis Christos, Stenzinger Albrecht, Volckmar Anna-Lena, Enk Alexander, Hassel Jessica C
Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany.
Department of Dermatology, University Hospital Tübingen, 72076 Tübingen, Germany.
Cancers (Basel). 2021 May 26;13(11):2616. doi: 10.3390/cancers13112616.
Checkpoint inhibitors have revolutionized the treatment of patients with metastasized melanoma. However, it remains unclear when to stop treatment. We retrospectively analyzed 45 patients (median age 64 years; 58% male) with metastasized melanoma from 3 cancer centers that received checkpoint inhibitors and discontinued therapy due to either immune-related adverse events or patient decision after an (F)2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) combined with a low-dose CT scan (FDG-PET-CT) scan without signs for disease progression. After a median of 21 (range 1-42) months of immunotherapy an FDG-PET-CT scan was performed to evaluate disease activity. In these, 32 patients (71%) showed a complete metabolic response (CMR) and 13 were classified as non-CMR. After a median follow-up of 34 (range 1-70) months, 3/32 (9%) of CMR patients and 6/13 (46%) of non-CMR patients had progressed ( = 0.007). Progression-free survival (PFS), as estimated from the date of last drug administration, was significantly longer among CMR patients than non-CMR (log-rank: = 0.001; hazard ratio: 0.127; 95% CI: 0.032-0.511). Two-year PFS was 94% among CMR patients and 62% among non-CMR patients. Univariable Cox regression showed that metabolic response was the only parameter which predicted PFS ( = 0.004). Multivariate analysis revealed that metabolic response predicted disease progression ( = 0.008). In conclusion, our findings suggest that patients with CMR in an FDG-PET-CT scan may have a favorable outcome even if checkpoint inhibition is discontinued.
检查点抑制剂彻底改变了转移性黑色素瘤患者的治疗方式。然而，何时停止治疗仍不明确。我们回顾性分析了来自3个癌症中心的45例（中位年龄64岁；58%为男性）转移性黑色素瘤患者，这些患者接受了检查点抑制剂治疗，并在（F）2-氟-2-脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）联合低剂量CT扫描（FDG-PET-CT）显示无疾病进展迹象后，因免疫相关不良事件或患者决定而停止治疗。在中位21（范围1-42）个月的免疫治疗后，进行了FDG-PET-CT扫描以评估疾病活动情况。其中，32例患者（71%）显示完全代谢缓解（CMR），13例被归类为非CMR。在中位随访34（范围1-70）个月后，32例CMR患者中有3例（9%）病情进展，13例非CMR患者中有6例（46%）病情进展（P = 0.007）。从最后一次给药日期估计的无进展生存期（PFS），CMR患者显著长于非CMR患者（对数秩检验：P = 0.001；风险比：0.127；95%置信区间：0.032-0.511）。CMR患者的两年PFS为94%，非CMR患者为62%。单变量Cox回归显示，代谢缓解是预测PFS的唯一参数（P = 0.004）。多变量分析显示，代谢缓解可预测疾病进展（P = 0.008）。总之，我们的研究结果表明，如果停止检查点抑制治疗，但FDG-PET-CT扫描显示CMR的患者可能有较好的预后。
