氟脱氧葡萄糖正电子发射断层扫描预测抗 PD-1 治疗转移性黑色素瘤的长期预后。
FDG-PET to predict long-term outcome from anti-PD-1 therapy in metastatic melanoma.
机构信息
Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
出版信息
Ann Oncol. 2022 Jan;33(1):99-106. doi: 10.1016/j.annonc.2021.10.003. Epub 2021 Oct 21.
BACKGROUND
We have previously shown that 75% of patients treated with programmed cell death protein 1 (PD-1) with or without CTLA4 who have not progressed by 1 year have complete metabolic response (CMR), including two-thirds of patients with partial response (PR). We now report 5-year outcomes.
PATIENTS AND METHODS
Retrospective analysis of 104 patients with baseline and 1-year positron emission tomography (PET) and computed tomography (CT). The 1-year response was determined using RECIST for CT and European Organisation for Research and Treatment of Cancer (EORTC) criteria for PET. Progression-free survival (PFS) and overall survival (OS) were determined from the 1-year landmark.
RESULTS
At the median follow-up of 61 months (range 58-64 months) from 1-year PET, 94% remained alive and all but one had discontinued treatment after a median treatment duration of 23 months (range 1-59 months). Disease progression occurred in 19 patients (18%): 10 (53%) while on treatment and 12 (63%) in solitary sites for which 8 (67%) received local treatment. RECIST PFS rate at 5 years after PET was higher in complete response (CR) compared with PR/stable disease (SD) (93% versus 76%, respectively) and CMR compared with non-CMR (90% versus 54%, respectively). In patients with PR, 5-year PFS rate was superior in CMR (88% and 59%). A total of 35 (34%) patients (14/29 in CR, 31/78 in CMR) discontinued treatment within 12 months, largely due to toxicity, with no impact on PFS rate compared with those that continued (84% versus 78%). Despite progression events, OS rate at 5 years was excellent and similar in patients with CR and PR/SD (100% versus 91%, respectively) as well as in those with CMR and non-CMR (96% versus 87%, respectively).
CONCLUSIONS
Five years after the 1-year PET, sustained responses are observed in the majority of patients, particularly in those with CMR. PET continues to predict progression better than CT, particularly in those with residual disease on CT. In the minority that progress, often in solitary sites and managed locally, OS rate remains excellent. PET is effective in evaluating residual lesions on CT and can predict long-term benefit.
背景
我们之前已经表明，在接受程序性死亡蛋白 1（PD-1）联合或不联合 CTLA4 治疗的患者中，有 75%的患者在 1 年内没有进展，这些患者的完全代谢缓解（CMR），包括三分之二的部分缓解（PR）患者。我们现在报告 5 年的结果。
患者和方法
回顾性分析了 104 例基线和 1 年正电子发射断层扫描（PET）和计算机断层扫描（CT）的患者。使用 CT 的 RECIST 和 PET 的欧洲癌症研究与治疗组织（EORTC）标准来确定 1 年的反应。从 1 年的时间点开始确定无进展生存期（PFS）和总生存期（OS）。
结果
从 1 年 PET 中位随访 61 个月（范围 58-64 个月）时，94%的患者仍然存活，除 1 例患者外，所有患者在中位治疗时间 23 个月（范围 1-59 个月）后停止治疗。19 例患者（18%）发生疾病进展：10 例（53%）在治疗中，12 例（63%）在孤立部位，其中 8 例（67%）接受了局部治疗。PET 后 5 年的 RECIST PFS 率在完全缓解（CR）患者中高于部分缓解/稳定疾病（PR/SD）患者（分别为 93%和 76%），在 CMR 患者中高于非 CMR 患者（分别为 90%和 54%）。在 PR 患者中，CMR 患者的 5 年 PFS 率更高（分别为 88%和 59%）。共有 35 例（34%）患者（CR 中 14/29 例，CMR 中 31/78 例）在 12 个月内停止治疗，主要是由于毒性，与继续治疗的患者相比，PFS 率没有差异（分别为 84%和 78%）。尽管发生了进展事件，但 CR 患者和 PR/SD 患者（分别为 100%和 91%）以及 CMR 和非 CMR 患者（分别为 96%和 87%）的 OS 率都很高，且相似。
结论
在 1 年 PET 后 5 年，大多数患者的持续反应得到观察，特别是在 CMR 患者中。PET 继续比 CT 更好地预测进展，特别是在 CT 上有残留疾病的患者中。在少数进展的患者中，通常在孤立部位，并且通过局部治疗进行管理，OS 率仍然很高。PET 能够有效地评估 CT 上的残留病变，并可以预测长期获益。
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