Imaging Characteristics and Diagnostic Performance of 2-deoxy-2-[18F]fluoro-D-Glucose PET/CT for Melanoma Patients Who Demonstrate Hyperprogressive Disease When Treated with Immunotherapy

Ryusuke Nakamoto; Lisa C Zaba; Jarrett Rosenberg; Sunil Arani Reddy; Tomomi W Nobashi; Valentina Ferri; Guido Davidzon; Carina Mari Aparici; Judy Nguyen; Farshad Moradi; Andrei Iagaru; Benjamin Lewis Franc

doi:10.1007/s11307-020-01526-4

Imaging Characteristics and Diagnostic Performance of 2-deoxy-2-[¹⁸F]fluoro-D-Glucose PET/CT for Melanoma Patients Who Demonstrate Hyperprogressive Disease When Treated with Immunotherapy

Mol Imaging Biol. 2021 Feb;23(1):139-147. doi: 10.1007/s11307-020-01526-4. Epub 2020 Aug 12.

Affiliations

¹ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5281, USA. inabook@stanford.edu.
² Department of Dermatology, Stanford University, Stanford, CA, USA.
³ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5281, USA.
⁴ Department of Oncology, Stanford University, Stanford, CA, USA.
⁵ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, USA.

PMID: 32789649
DOI: 10.1007/s11307-020-01526-4

Abstract

Purpose: We investigated the ability of baseline 2-deoxy-2-[¹⁸F]fluoro-D-glucose PET/CT parameters, acquired before the start of immunotherapy, to predict development of hyperprogressive disease (HPD) in melanoma patients. We also evaluated the diagnostic performances of ratios of baseline and first restaging PET/CT parameters to diagnose HPD without information of the tumor growth kinetic ratio (TGKR) that requires pre-baseline imaging before baseline imaging (3 timepoint imaging).

Procedures: Seventy-six patients who underwent PET/CT before and approximately 3 months following initiation of immunotherapy were included. PET/CT parameters, including metabolic tumor volume (MTV) for all melanoma lesions and total measured tumor burden (TMTB) based on irRECIST, were measured from baseline PET/CT (MTV_base and TMTB_base) and first restaging PET/CT (MTV_post and TMTB_post). The ratios of MTV (MTV_post/MTV_base, MTVr) and TMTB (TMTB_post/TMTB_base, TMTBr) were calculated.

Results: MTV_base of HPD patients (n = 9, TGKR ≥ 2) was larger than that of non-HPD (n = 67, TGKR < 2) patients (P < 0.05), and HPD patients demonstrated shorter median overall survival (7 vs. more than 60 months, P < 0.05). The area under the curve (AUC) of MTV_base (≥ 155.5 ml) to predict the risk of HPD was 0.703, with a sensitivity of 66.7 % and specificity of 81.2 %. The AUCs of MTVr (≥ 1.25) and TMTBr (≥ 1.27) to diagnose HPD without information of TGKR were 0.875 and 0.977 with both sensitivities of 100 %, and specificities of 79 % and 83.9 %, respectively.

Conclusions: Patients at high risk of developing HPD could not be accurately identified based on baseline PET/CT parameters. The ratios of baseline and first restaging PET/CT parameters may be helpful to diagnose HPD, when patients do not undergo pre-baseline imaging.

Keywords: FDG; HPD; Hyperprogressive disease; Immunotherapy; Melanoma; PET/CT.

MeSH terms

Aged
Disease Progression*
Female
Fluorodeoxyglucose F18 / chemistry*
Humans
Immunotherapy*
Kaplan-Meier Estimate
Kinetics
Male
Melanoma / diagnosis
Melanoma / diagnostic imaging*
Melanoma / therapy*
Middle Aged
Positron Emission Tomography Computed Tomography*
ROC Curve
Skin Neoplasms / diagnosis
Skin Neoplasms / diagnostic imaging*
Skin Neoplasms / therapy*
Tumor Burden

Substances

Fluorodeoxyglucose F18