open access publication

Article, 2024

Prospective Assessment of Fluorine-18-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography (FDG-PET/CT) for Early Identification of Checkpoint-Inhibitor-Induced Pseudoprogression

Cancers, ISSN 2072-6694, Volume 16, 5, Page 964, 10.3390/cancers16050964

Contributors

Homburg, Sif 0000-0001-6391-4000 [1] Christensen, Charlotte Birk [1] Pedersen, Magnus [1] Sørensen, Simon Grund 0000-0001-5494-9375 [2] Donia, Marco V 0000-0003-4966-9752 [1] Svane, Inge Marie Stentoft 0000-0002-9451-6037 [1] Hendel, Helle Westergren 0000-0002-6213-0148 [1] Ellebaek, Eva 0000-0001-6748-9232 (Corresponding author) [1]

Affiliations

  1. [1] Copenhagen University Hospital
    2. [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
  2. [2] Aarhus University Hospital
    3. [NORA names: Central Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD]

Abstract

The activity of immune checkpoint inhibitors (ICIs) in patients with metastatic melanoma is often monitored using fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scans. However, distinguishing disease progression (PD) from pseudoprogression (PsPD), where increased FDG uptake might reflect immune cell activity rather than tumor growth, remains a challenge. This prospective study compared the efficacy of dual-time point (DTP) FDG-PET/CT with modified response criteria (PERCIMT) in differentiating PsPD from PD. From July 2017-January 2021, 41 patients suspected to have PsPD on an evaluation scan were prospectively included (29 evaluable). A subsequent DTP FDG-PET/CT scan was conducted within 14 days, followed by a confirmatory FDG-PET/CT scan. Additionally, PERCIMT were applied. DTP FDG-PET/CT identified 24% with PsPD and 76% with PD. Applying PERCIMT criteria, 69% showed PsPD, while 31% had PD. On follow-up, 10 patients (34%) demonstrated confirmed PsPD, while 19 (66%) exhibited PD. The sensitivity and specificity of DTP FDG-PET/CT were 20% and 74%, respectively, and for PERCIMT this was 80% and 37%, respectively. Our findings suggest limited efficacy of DTP FDG-PET/CT in distinguishing PsPD from PD in ICI-treated patients with metastatic melanoma. The use of PERCIMT could complement clinical assessment and be incorporated in multidisciplinary team conferences for enhanced decision-making.

Keywords

FDG uptake, FDG-PET/CT, FDG-PET/CT scans, ICI-treated patients, PERCIMT, PSPD, Pd, activity, activity of immune checkpoint inhibitors, cell activation, checkpoint inhibitors, conference, criteria, days, decision-making, disease, disease progression, dual-time point, early identification, efficacy, emission tomography/computed tomography, enhance decision-making, evaluable scans, evaluation, findings, fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography, follow-up, growth, immune cell activation, immune checkpoint inhibitors, increased FDG uptake, inhibitors, melanoma, metastatic melanoma, modified response criteria, multidisciplinary team conference, patients, point, progression, prospective assessment, prospective study, pseudoprogression, response criteria, scanning, sensitivity, specificity, study, team conferences, tomography, tomography/computed tomography, tumor, tumor growth, uptake

Funders

  • Capital Region of Denmark

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