Organ-specific accuracy of [18F]FDG-PET/CT in identifying immune-related adverse events in patients with high-risk melanoma treated with adjuvant immune checkpoint inhibitor

Birte Molvik Gideonse; Magnus Birkeland; Mie Holm Vilstrup; Peter Grupe; Mohammad Naghavi-Behzad; Christina H Ruhlmann; Oke Gerke; Malene Grubbe Hildebrandt

doi:10.1007/s11604-024-01554-y

Organ-specific accuracy of [¹⁸F]FDG-PET/CT in identifying immune-related adverse events in patients with high-risk melanoma treated with adjuvant immune checkpoint inhibitor

Jpn J Radiol. 2024 Mar 20. doi: 10.1007/s11604-024-01554-y. Online ahead of print.

Authors

Birte Molvik Gideonse^#^{1

2}, Magnus Birkeland^#^{1

2}, Mie Holm Vilstrup^{1

2

3}, Peter Grupe^{1

2}, Mohammad Naghavi-Behzad^{4

5

6}, Christina H Ruhlmann^{1

7}, Oke Gerke^{1

2}, Malene Grubbe Hildebrandt^{1

2

8

9}

Affiliations

¹ Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
² Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
³ Department of Radiology and Nuclear Medicine, Esbjerg Hospital, Esbjerg, Denmark.
⁴ Department of Clinical Research, University of Southern Denmark, Odense, Denmark. MNB91@rsyd.dk.
⁵ Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. MNB91@rsyd.dk.
⁶ Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark. MNB91@rsyd.dk.
⁷ Department of Oncology, Odense University Hospital, Odense, Denmark.
⁸ Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark.
⁹ Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.

^# Contributed equally.

PMID: 38504000
DOI: 10.1007/s11604-024-01554-y

Abstract

Purpose: This study aimed to determine the organ-specific accuracy of [¹⁸F]FDG-PET/CT in identifying immune-related adverse events (irAEs) in patients with high-risk (stage III/IV) surgically resected melanoma treated with an adjuvant immune checkpoint inhibitor (ICI) and determine the incidence of irAEs within the first year after starting treatment.

Materials and methods: This registry-based study included individuals who had undergone surgical removal of melanoma and were undergoing adjuvant ICI treatment (either nivolumab or pembrolizumab). The study specifically enrolled patients who had undergone both a baseline and at least one subsequent follow-up [¹⁸F]FDG-PET/CT scan. Follow-up scans were performed every third month in the first year after surgery to screen for disease recurrence. We retrospectively compared the follow-up scans with baseline scans to identify irAEs. Clinical information on irAEs was obtained from medical records and served as a reference standard for determining the accuracy of [¹⁸F]FDG-PET/CT.

Results: A total of 123 patients with 363 [¹⁸F]FDG-PET/CT scans were included, and 65 patients (52.8%) developed irAEs. In decreasing order, the organ-specific incidences of irAEs were: skin 26/65 (40%), muscle and joints 21/65 (32.3%), intestines 13/65 (20%), thyroid gland 12/65 (18.5%), lungs 4/65 (6.2%), and heart 2/65 (3.1%). The sensitivities and specificities of [¹⁸F]FDG-PET/CT for diagnosing irAEs were: skin 19% (95% CI: 7-39%) and 95% (88-98%), muscles and joints 71% (48-89%) and 83% (75-90%), intestines 100% (75-100%) and 85% (77-91%); thyroid gland 92% (62-99%) and 95% (89-98%), lungs 75% (19-99%) and 90% (83-95%), and heart 50% (13-99%) and 97% (92-99%), respectively.

Conclusion: [¹⁸F]FDG-PET/CT generally had moderate to high sensitivities (except for skin and heart) and specificities in diagnosing irAEs in patients receiving adjuvant ICI; this could be suggested to be systematically assessed and reported in scan reports.

Keywords: Immune checkpoint inhibitor; Immune-related adverse events; Melanoma; [18F]FDG-PET/CT; irAEs.

Grants and funding

Centre for Personalized Response Monitoring in Oncology (PREMIO)/Odense Universitetshospital