From the Molecular Imaging and Therapeutic Nuclear Medicine (A.I.) and Department of Oncology (R.W., S.S.), Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology (A.I., S.S.) and St Vincent's Hospital Department of Medicine (A.G., R.J.H.), University of Melbourne, Melbourne, Australia; Department of Radiology, University of Washington, Seattle, Wash (A.I.); Melanoma Institute Australia, University of Sydney, North Sydney, Australia (S.N.L.); Faculty of Health and Medicine, University of Sydney, Sydney, Australia (S.N.L.); Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (S.N.L.); Immunology and Diabetes Unit, St Vincent's Institute of Medical Research, Melbourne, Australia (A.G.); Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Australia (A.G.); and Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada (A.M.W.).
Radiology. 2023 May;307(3):e221180. doi: 10.1148/radiol.221180. Epub 2023 Feb 28.
Background Despite improved response to combined ipilimumab and nivolumab (hereafter, IpiNivo) treatment for advanced melanoma, many patients exhibit primary or acquired resistance. This, combined with high risk of immune-related adverse events, makes identifying markers predictive of outcomes desirable. Purpose To investigate the prognostic value of fluorine 18 (F) fluorodeoxyglucose (FDG) PET/CT parameters at baseline and as part of response monitoring in patients with advanced melanoma undergoing IpiNivo treatment. Materials and Methods This was a single-center retrospective study of adult patients with melanoma who received IpiNivo. Baseline FDG PET/CT parameters that included metabolic tumor volume (MTV), tumor stage, mutation status, Eastern Cooperative Oncology Group performance score, lactate dehydrogenase level, and treatment line were correlated with overall survival in univariable and multivariable Cox regression analyses. Treatment response as determined with FDG PET/CT was correlated with overall survival. Results In total, 122 patients (median age, 61 years [IQR, 51-69 years]; 89 men) were included; 78% (95 of 122) had an Eastern Cooperative Oncology Group score of 0, 52% (45 of 86) had an elevated lactate dehydrogenase level, 39% (48 of 122) had a metastatic stage of M1c and 45% (55 of 122) M1d, 45% (55 of 122) had V600E/K mutation, and the median MTV was 42 mL. Patients with a higher than median MTV at baseline FDG PET/CT had a lower 12-month survival rate compared with those with a lower than median MTV (43% [95% CI: 32, 58] vs 66% [95% CI: 55, 79], < .001). In multivariable analysis, higher versus lower than median MTV, Eastern Cooperative Oncology Group performance scores of 1-2 versus 0, and subsequent versus first-line IpiNivo treatment were independently associated with overall survival (hazard ratio [HR]: 1.68 [95% CI: 1.02, 2.78], = .04; 3.1 [95% CI: 1.8, 5.4], < .001; and 11.2 [95% CI: 3.4, 37.1], = .002, respectively). The 12-month overall survival rate was lower in patients with progressive disease than in those without progression (35% [95% CI: 24, 51] vs 90% [95% CI: 83, 99]; HR, 7.3 [95% CI: 3.9, 13.3]; < .001). Conclusion Baseline fluorine 18 fluorodeoxyglucose PET/CT metabolic tumor volume was an independent prognostic marker in patients with advanced melanoma who received ipilimumab and nivolumab treatment. © RSNA, 2023
背景 尽管联合使用伊匹单抗和纳武利尤单抗（以下简称 IpiNivo）治疗晚期黑色素瘤的反应有所改善，但许多患者仍表现出原发或获得性耐药。此外，这种治疗还伴随着发生免疫相关不良事件的高风险，因此寻找能够预测疗效的标志物成为了理想的选择。目的 旨在探讨氟 18（F）氟脱氧葡萄糖（FDG）PET/CT 基线参数和作为反应监测的一部分，在接受 IpiNivo 治疗的晚期黑色素瘤患者中的预后价值。材料与方法 这是一项单中心回顾性研究，纳入了接受 IpiNivo 治疗的成年黑色素瘤患者。单变量和多变量 Cox 回归分析中，将包括代谢肿瘤体积（MTV）、肿瘤分期、突变状态、东部肿瘤协作组体能状态评分、乳酸脱氢酶水平和治疗线在内的基线 FDG PET/CT 参数与总生存进行相关性分析。用 FDG PET/CT 确定的治疗反应与总生存进行相关性分析。结果 共纳入 122 例患者（中位年龄，61 岁[IQR，51-69 岁]；89 例男性）；78%（95/122）患者东部肿瘤协作组评分为 0，52%（45/86）患者乳酸脱氢酶水平升高，39%（48/122）患者存在 M1c 期转移，45%（55/122）患者存在 M1d 期转移，45%（55/122）患者存在 V600E/K 突变，中位 MTV 为 42 mL。与 MTV 较低的患者相比，基线 FDG PET/CT 中 MTV 较高的患者 12 个月生存率较低（43%[95%CI：32，58]vs 66%[95%CI：55，79]，<.001）。多变量分析中，与 MTV 较高相比，MTV 较低、东部肿瘤协作组体能状态评分为 1-2 分与 0 分、二线 IpiNivo 治疗与一线 IpiNivo 治疗与总生存独立相关（风险比[HR]：1.68[95%CI：1.02，2.78]，=.04；3.1[95%CI：1.8，5.4]，<.001；和 11.2[95%CI：3.4，37.1]，=.002）。与无进展患者相比，疾病进展患者的 12 个月总生存率较低（35%[95%CI：24，51]vs 90%[95%CI：83，99]；HR，7.3[95%CI：3.9，13.3]；<.001）。结论 基线氟 18 氟脱氧葡萄糖 PET/CT 代谢肿瘤体积是接受伊匹单抗和纳武利尤单抗治疗的晚期黑色素瘤患者的独立预后标志物。
