[F]FDG-PET/CT 对非小细胞肺癌患者免疫治疗的非典型反应模式：长期预后评估和临床管理建议。
[F]FDG-PET/CT atypical response patterns to immunotherapy in non-small cell lung cancer patients: long term prognosis assessment and clinical management proposal.
机构信息
Centre Antoine Lacassagne, Nuclear Medicine Department, 33 Avenue de Valombrose, 06100, Nice, France.
Université Côte D'Azur, CNRS, Inserm, iBV, Nice, France.
出版信息
Eur J Nucl Med Mol Imaging. 2024 Oct;51(12):3696-3708. doi: 10.1007/s00259-024-06794-8. Epub 2024 Jun 19.
AIM
To determine the long-term prognosis of immune-related response profiles (pseudoprogression and dissociated response), not covered by conventional PERCIST criteria, in patients with non-small-cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICPIs).
METHODS
109 patients were prospectively included and underwent [F]FDG-PET/CT at baseline, after 7 weeks (PET1), and 3 months (PET2) of treatment. On PET1, tumor response was assessed using standard PERCIST criteria. In the event of PERCIST progression at this time-point, the study design provided for continued immunotherapy for 6 more weeks. Additional response patterns were then considered on PET2: pseudo-progression (PsPD, subsequent metabolic response); dissociated response (DR, coexistence of responding and non-responding lesions), and confirmed progressive metabolic disease (cPMD, subsequent homogeneous progression of lesions). Patients were followed up for at least 12 months.
RESULTS
Median follow-up was 21 months. At PET1, PERCIST progression was observed in 60% (66/109) of patients and ICPI was continued in 59/66. At the subsequent PET2, 14% of patients showed PsPD, 11% DR, 35% cPMD, and 28% had a sustained metabolic response. Median overall survival (OS) and progression-free-survival (PFS) did not differ between PsPD and DR (27 vs 29 months, p = 1.0; 17 vs 12 months, p = 0.2, respectively). The OS and PFS of PsPD/DR patients were significantly better than those with cPMD (29 vs 9 months, p < 0.02; 16 vs 2 months, p < 0.001), but worse than those with sustained metabolic response (p < 0.001). This 3-group prognostic stratification enabled better identification of true progressors, outperforming the prognostic value of standard PERCIST criteria (p = 0.03).
CONCLUSION
[F]FDG-PET/CT enables early assessment of response to immunotherapy. The new wsPERCIST ("wait and see") PET criteria proposed, comprising immune-related atypical response patterns, can refine conventional prognostic stratification based on PERCIST criteria.
TRIAL REGISTRATION
HDH F20230309081206. Registered 20 April 2023. Retrospectively registered.
目的
确定非小细胞肺癌（NSCLC）患者接受免疫检查点抑制剂（ICPIs）治疗后，未被常规 PERCIST 标准涵盖的免疫相关反应谱（假性进展和分离反应）的长期预后。
方法
前瞻性纳入 109 例患者，分别在基线、治疗 7 周（PET1）和 3 个月（PET2）时进行[F]FDG-PET/CT。在 PET1 时，使用标准 PERCIST 标准评估肿瘤反应。如果此时 PERCIST 进展，研究设计规定继续免疫治疗 6 周。然后在 PET2 时考虑其他反应模式：假性进展（PsPD，随后代谢反应）；分离反应（DR，同时存在反应和非反应病变）和确认进行性代谢疾病（cPMD，病变随后均匀进展）。患者至少随访 12 个月。
结果
中位随访时间为 21 个月。在 PET1 时，60%（66/109）的患者出现 PERCIST 进展，59/66 例继续接受 ICPI 治疗。在随后的 PET2 时，14%的患者出现 PsPD，11%的患者出现 DR，35%的患者出现 cPMD，28%的患者出现持续代谢反应。PsPD 和 DR 之间的中位总生存期（OS）和无进展生存期（PFS）无差异（27 与 29 个月，p=1.0；17 与 12 个月，p=0.2）。PsPD/DR 患者的 OS 和 PFS 明显优于 cPMD 患者（29 与 9 个月，p<0.02；16 与 2 个月，p<0.001），但劣于持续代谢反应患者（p<0.001）。这种 3 组预后分层能够更好地识别真正的进展者，优于标准 PERCIST 标准的预后价值（p=0.03）。
结论
[F]FDG-PET/CT 能够早期评估免疫治疗反应。提出的新的 wsPERCIST（“等待观察”）PET 标准包括免疫相关的非典型反应模式，可以细化基于 PERCIST 标准的常规预后分层。
试验注册
HDH F20230309081206。2023 年 4 月 20 日注册。回顾性注册。
Zotero 插件