基于[18F]FDG PET/CT对接受伊匹单抗和纳武单抗+/-UV1端粒酶疫苗治疗的胸膜间皮瘤患者的预后预测。
Outcome prediction based on [18F]FDG PET/CT in patients with pleural mesothelioma treated with ipilimumab and nivolumab +/- UV1 telomerase vaccine.
作者信息
Thunold Solfrid, Hernes Eivor, Farooqi Saima, Öjlert Åsa Kristina, Francis Roslyn J, Nowak Anna K, Szejniuk Weronika Maria, Nielsen Søren Steen, Cedres Susana, Perdigo Marc Simo, Sørensen Jens Benn, Meltzer Carin, Mikalsen Lars Tore Gyland, Helland Åslaug, Malinen Eirik, Haakensen Vilde Drageset
机构信息
Dept of Oncology, Oslo University Hospital, Oslo, Norway.
Dept of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
出版信息
Eur J Nucl Med Mol Imaging. 2025 Jan;52(2):693-707. doi: 10.1007/s00259-024-06853-0. Epub 2024 Aug 12.
PURPOSE
The introduction of immunotherapy in pleural mesothelioma (PM) has highlighted the need for effective outcome predictors. This study explores the role of [18F]FDG PET/CT in predicting outcomes in PM treated with immunotherapy.
METHODS
Patients from the NIPU trial, receiving ipilimumab and nivolumab +/- telomerase vaccine in second-line, were included. [18F]FDG PET/CT was obtained at baseline (n = 100) and at week-5 (n = 76). Metabolic tumour volume (MTV) and peak standardised uptake value (SUV) were evaluated in relation to survival outcomes. Wilcoxon rank-sum test was used to assess differences in MTV, total lesion glycolysis (TLG), maximum standardised uptake value (SUV) and SUV between patients exhibiting an objective response, defined as either partial response or complete response according to the modified Response Criteria in Solid Tumours (mRECIST) and immune RECIST (iRECIST), and non-responders, defined as either stable disease or progressive disease as their best overall response.
RESULTS
Univariate Cox regression revealed significant associations of MTV with OS (HR 1.36, CI: 1.14, 1.62, p < 0.001) and PFS (HR 1.18, CI: 1.03, 1.34, p = 0.02), while multivariate analysis showed a significant association with OS only (HR 1.35, CI: 1.09, 1.68, p = 0.007). While SUV was not significantly associated with OS or PFS in univariate analyses, it was significantly associated with OS in multivariate analysis (HR 0.43, CI: 0.23, 0.80, p = 0.008). Objective responders had significant reductions in TLG, SUV and SUV at week-5.
CONCLUSION
MTV provides prognostic value in PM treated with immunotherapy. High SUV was not associated with inferior outcomes, which could be attributed to the distinct mechanisms of immunotherapy. Early reductions in PET metrics correlated with treatment response.
STUDY REGISTRATION
The NIPU trial (NCT04300244) is registered at clinicaltrials.gov. https://classic.
CLINICALTRIALS
gov/ct2/show/NCT04300244?cond=Pleural+Mesothelioma&cntry=NO&draw=2&rank=4.
目的
免疫疗法引入胸膜间皮瘤（PM）治疗后，凸显了对有效预后预测指标的需求。本研究探讨[18F]FDG PET/CT在预测接受免疫疗法治疗的PM患者预后中的作用。
方法
纳入NIPU试验中接受二线伊匹单抗和纳武单抗+/-端粒酶疫苗治疗的患者。在基线时（n = 100）和第5周时（n = 76）进行[18F]FDG PET/CT检查。根据实体瘤改良疗效评价标准（mRECIST）和免疫疗效评价标准（iRECIST），将客观缓解定义为部分缓解或完全缓解，疾病稳定或疾病进展定义为最佳总体缓解，评估代谢肿瘤体积（MTV）和峰值标准化摄取值（SUV）与生存结局的关系。采用Wilcoxon秩和检验评估客观缓解者与未缓解者在MTV、总病变糖酵解（TLG）、最大标准化摄取值（SUV）和SUV方面的差异。
结果
单因素Cox回归显示MTV与总生存期（OS，风险比[HR] 1.36，置信区间[CI]：1.14，1.62，p < 0.001）和无进展生存期（PFS，HR 1.18，CI：1.03，1.34，p = 0.02）显著相关，而多因素分析显示仅与OS显著相关（HR 1.35，CI：1.09，1.68，p = 0.007）。虽然在单因素分析中SUV与OS或PFS无显著相关性，但在多因素分析中与OS显著相关（HR 0.43，CI：0.23，0.80，p = 0.008）。客观缓解者在第5周时TLG、SUV和SUV显著降低。
结论
MTV在接受免疫疗法治疗的PM中具有预后价值。高SUV与较差结局无关，这可能归因于免疫疗法的独特机制。PET指标的早期降低与治疗反应相关。
研究注册
NIPU试验（NCT04300244）已在clinicaltrials.gov注册。https://classic.
临床试验
gov/ct2/show/NCT04300244?cond=Pleural+Mesothelioma&cntry=NO&draw=2&rank=4 。
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