Department of Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.
Department of Respiratory Medicine, Hidaka Hospital, 886, Nakao-cho, Takasaki, 370-0001, Japan.
Sci Rep. 2022 Jul 12;12(1):11832. doi: 10.1038/s41598-022-15964-3.
Anti-programmed death-1 (PD-1) blockade is a standard treatment for advanced non-small-cell lung cancer (NSCLC). However, no appropriate modality exists for monitoring its therapeutic response immediately after initiation. Therefore, we aimed to elucidate the clinical relevance of F-FDG PET/CT versus CT in predicting the response to PD-1 blockade in the early phase. This prospective study included a total of 54 NSCLC patients. F-FDG PET/CT was performed at 4 weeks and 9 weeks after PD-1 blockade monotherapy. Maximum standardized uptake values (SUL), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were evaluated. Among all patients, partial metabolic response and progressive metabolic disease after PD-1 blockade were observed in 35.2% and 11.1% on SUL, 22.2% and 51.8% on MTV, and 27.8% and 46.3% on TLG, respectively, whereas a partial response (PR) and progressive disease (PD), respectively, based on RECIST v1.1 were recognized in 35.2% and 35.2%, respectively. The predictive probability of PR (MTV: 57.9% vs. 21.1%, p = 0.044; TLG: 63.2% vs. 21.1%, p = 0.020) and PD (MTV: 78.9% vs. 47.3%, p = 0.002; TLG: 73.7% vs. 21.1%, p = 0.007) detected based on RECIST at 4 weeks after PD-1 blockade initiation was significantly higher using MTV or TLG on F-FDG uptake than on CT. Multivariate analysis revealed that metabolic response by MTV or TLG at 4 weeks was an independent factor for response to PD-1 blockade treatment. Metabolic assessment by MTV or TLG was superior to morphological changes on CT for predicting the therapeutic response and survival at 4 weeks after PD-1 blockade.
抗程序性死亡-1（PD-1）阻断是晚期非小细胞肺癌（NSCLC）的标准治疗方法。然而，在开始后立即监测其治疗反应尚无合适的方法。因此，我们旨在阐明 F-FDG PET/CT 与 CT 在预测 PD-1 阻断早期反应方面的临床相关性。这项前瞻性研究共纳入 54 例 NSCLC 患者。PD-1 单药治疗后 4 周和 9 周进行 F-FDG PET/CT。评估最大标准化摄取值（SUL）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）。在所有患者中，PD-1 阻断后 SUL 上观察到部分代谢反应和进行性代谢疾病的分别为 35.2%和 11.1%，MTV 上分别为 22.2%和 51.8%，TLG 上分别为 27.8%和 46.3%，而根据 RECIST v1.1 分别为部分缓解（PR）和进展性疾病（PD）的分别为 35.2%和 35.2%。4 周时根据 RECIST 检测到的 PR（MTV：57.9%比 21.1%，p=0.044；TLG：63.2%比 21.1%，p=0.020）和 PD（MTV：78.9%比 47.3%，p=0.002；TLG：73.7%比 21.1%，p=0.007）的预测概率显著高于 PD-1 阻断后 4 周时 MTV 或 TLG 上的 CT。多变量分析显示，4 周时 MTV 或 TLG 的代谢反应是对 PD-1 阻断治疗反应的独立因素。MTV 或 TLG 的代谢评估优于 CT 上的形态学变化，可预测 PD-1 阻断后 4 周时的治疗反应和生存。
