DOI: 10.1007/s00259-017-3806-1Pages: 56-66

Metabolic activity by 18F–FDG-PET/CT is predictive of early response after nivolumab in previously treated NSCLC

1. Gunma University Graduate School of Medicine, Department of Oncology Clinical Development

2. Gunma University Graduate School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine

3. Hidaka Hospital, Department of Respiratory Medicine

4. Hidaka Hospital, Department of Radiology

5. Gunma University Graduate School of Medicine, Department of General Surgical Science

6. Gunma University Hospital, Oncology Center

7. Gunma University Hospital, Department of Respiratory Medicine

8. National Cancer Center Hospital, Department of Experimental Therapeutics

9. Gunma University Initiative for Advanced Research, Big Data Center for Integrative Analysis

10. Gunma University Initiative for Advanced Research, Division of Integrated Oncology Research, Research Program for Omics-based Medical Science

11. Clinical Research Support Center, Shizuoka Cancer Center

12. Gunma University Graduate School of Medicine, Department of Molecular Pharmacology and Oncology

13. Gunma University Initiative for Advanced Research (GIAR), Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research

Correspondence to:
Kyoichi Kaira
Tel: +81 27 220 8136
Email: kkaira1970@yahoo.co.jp

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Abstract

Background

Nivolumab, an anti-programmed death-1 (PD-1) antibody, is administered in patients with previously treated non-small cell lung cancer. However, little is known about the established biomarker predicting the efficacy of nivolumab. Here, we conducted a preliminary study to investigate whether 18F–FDG-PET/CT could predict the therapeutic response of nivolumab at the early phase.

Methods

Twenty-four patients were enrolled in this study. 18F–FDG-PET/CT was carried out before and 1 month after nivolumab therapy. SUVmax, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were calculated. Immunohistochemical analysis of PD-L1 expression and tumour-infiltrating lymphocytes was conducted.

Results

Among all patients, a partial metabolic response to nivolumab was observed in 29% on SUVmax, 25% on MTV, and 33% on TLG, whereas seven (29%) patients achieved a partial response (PR) based on RECIST v1.1. The predictive probability of PR (100% vs. 29%, p = 0.021) and progressive disease (100% vs. 22.2%, p = 0.002) at 1 month after nivolumab initiation was significantly higher in 18F–FDG on PET/CT than in CT scans. Multivariate analysis confirmed that 18F–FDG uptake after administration of nivolumab was an independent prognostic factor. PD-L1 expression and nivolumab plasma concentration could not precisely predict the early therapeutic efficacy of nivolumab.

Conclusion

Metabolic response by 18F–FDG was effective in predicting efficacy and survival at 1 month after nivolumab treatment.

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  • Accepted: Aug 7, 2017
  • Online: Aug 21, 2017

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