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F. Semah
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MA10 - Facing the Real World: New Staging System and Response Evaluation in Immunotherapy (ID 393)
- Event: WCLC 2016
- Type: Mini Oral Session
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:P. Kosmidis
- Coordinates: 12/06/2016, 14:20 - 15:50, Stolz 2
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MA10.10 - [18F]-FDG-PET/CT Early Response to Nivolumab in NSCLC (ID 6211)
15:26 - 15:32 | Author(s): F. Semah
- Abstract
- Presentation
Background:
Nivolumab is approved for treatment of squamous and non-squamous advanced NSCLC. Since nivolumab restores antitumor immunity, it is not clear whether 18F-FDG-PET/CT is able to distinguish response from tumor progression. We evaluated early metabolic patterns of response to nivolumab in advanced NSCLC patients.
Methods:
We retrospectively reviewed PET/CT scans and paired CT scans from 22 patients with advanced NSCLC who received nivolumab 3mg/kg every 2 weeks and performed PET/CT before and after 4 infusions of nivulomab. Total Lesion Glycolysis (TLG) and Metabolic Tumor Volume (MTV) of every lesion up to 5 per patient were measured on baseline and follow-up PET/CT. Percentage changes in MTV (ΔMTV) and TLG (ΔTLG) between the two PET/CT were calculated. Patients were classified into responders (nivolumab for >6 months), non responders (nivolumab ≤6 months) or having pseudo-progression (PP, nivolumab and clinical benefit >6 months despite initial progressive disease according to RECIST criteria)
Results:
Among 22 patients, 6 (27%) were responders, 15 (68%) were non-responders and 1 (4.5%) had PP. Baseline MTV and TLG were significantly lower in responders than in non-responders (medians 27 vs. 63 mL, p=0.03 and 124 vs. 254 g, p=0.04, respectively). After 4 infusions of nivolumab, metabolic parameters were significantly lower in responders than in non-responders (median MTV : 2 vs. 148 mL, p=0.001 and median TLG : 6 vs. 835 g, p=0.002). Mean ΔMTV and ΔTLG were both -88% in responders, and +236% and +312% respectively in non-responders, which was significantly different (p=0.0005). The only patient with PP had lower ΔMTV (+11%) and ΔTLG (+41%) than non-responders patients.
Conclusion:
In NSCLC, objective response and disease progression upon nivolumab usually translate into early and clear-cut patterns of change in PET/CT. Early PET/CT may help to distinguish progression from pseudo-progression.
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