First-Line Pembrolizumab Therapy of Non-Small Cell Lung Cancer: Baseline Metabolic Biomarkers Predict Outcomes

Quantitative biomarkers derived from positron-emission tomography/computed tomography (PET/CT) have been suggested as prognostic variables in immune-checkpoint inhibitor (ICI) treated non-small cell lung cancer (NSCLC). As such data for first-line ICI therapy and especially for chemotherapy-ICI combinations are still scarce, we retrospectively evaluated baseline 18F-FDG-PET/CT of 85 consecutive patients receiving first-line pembrolizumab with chemotherapy (n=70) or as monotherapy (n=15). Maximum and mean standardized uptake value, metabolic tumor volume (MTV), total lesion glycolysis and bone marrow-/ spleen to liver ratio (BLR/SLR) were calculated. Kaplan-Meier analyses and Cox-regression models were used to assess progression-free/overall survival (PFS/OS) and their determinant variables. Multivariate selection for PFS/OS revealed MTV as most relevant PET/CT biomarker (p<0.001). Median PFS/OS were significantly longer in patients with MTV≤70mL versus >70mL (PFS: 10 months (M; 95% confidence interval 4-16) vs. 4M (3-5), p=0.001; OS: not reached vs. 10M (5-15), p=0.004). Disease control rate was 81% vs. 53% for MTV≤/>70mL (p=0.007). BLR ≤1.06 versus >1.06 was associated with better outcomes (PFS: 8M (4-13) vs. 4M (3-6), p=0.034; OS: 19M (12-/) vs. 6M (4-12), p=0.005). In patients with MTV>70mL, concomitant BLR≤1.06 indicated a better prognosis. Higher MTV is associated with inferior PFS/OS in first-line ICI treated NSCLC, with BLR allowing additional risk stratification.

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First-Line Pembrolizumab Mono- or Combination Therapy of Non-Small Cell Lung Cancer: Baseline Metabolic Biomarkers Predict Outcomes

Cancers ◽

10.3390/cancers13236096 ◽

2021 ◽

Vol 13 (23) ◽

pp. 6096

Author(s):

David Lang ◽

Linda Ritzberger ◽

Vanessa Rambousek ◽

Andreas Horner ◽

Romana Wass ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Cox Regression ◽

Standardized Uptake Value ◽

Metabolic Tumor Volume ◽

Small Cell ◽

Small Cell Lung ◽

First Line ◽

Pet Ct

Quantitative biomarkers derived from positron-emission tomography/computed tomography (PET/CT) have been suggested as prognostic variables in immune-checkpoint inhibitor (ICI) treated non-small cell lung cancer (NSCLC). As such, data for first-line ICI therapy and especially for chemotherapy–ICI combinations are still scarce, we retrospectively evaluated baseline 18F-FDG-PET/CT of 85 consecutive patients receiving first-line pembrolizumab with chemotherapy (n = 70) or as monotherapy (n = 15). Maximum and mean standardized uptake value, total metabolic tumor volume (MTV), total lesion glycolysis, bone marrow-/and spleen to liver ratio (BLR/SLR) were calculated. Kaplan–Meier analyses and Cox regression models were used to assess progression-free/overall survival (PFS/OS) and their determinant variables. Median follow-up was 12 months (M; 95% confidence interval 10–14). Multivariate selection for PFS/OS revealed MTV as most relevant PET/CT biomarker (p < 0.001). Median PFS/OS were significantly longer in patients with MTV ≤ 70 mL vs. >70 mL (PFS: 10 M (4–16) vs. 4 M (3–5), p = 0.001; OS: not reached vs. 10 M (5–15), p = 0.004). Disease control rate was 81% vs. 53% for MTV ≤/> 70 mL (p = 0.007). BLR ≤ 1.06 vs. >1.06 was associated with better outcomes (PFS: 8 M (4–13) vs. 4 M (3–6), p = 0.034; OS: 19 M (12-/) vs. 6 M (4–12), p = 0.005). In patients with MTV > 70 mL, concomitant BLR ≤ 1.06 indicated a better prognosis. Higher MTV is associated with inferior PFS/OS in first-line ICI-treated NSCLC, with BLR allowing additional risk stratification.

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Prognostic and Predictive Values of Metabolic Parameters of 18F-FDG PET/CT in Patients With Non-Small Cell Lung Cancer Treated With Chemotherapy

Molecular Imaging ◽

10.1177/1536012119846025 ◽

2019 ◽

Vol 18 ◽

pp. 153601211984602 ◽

Cited By ~ 1

Author(s):

Xueyan Li ◽

Dawei Wang ◽

Lijuan Yu

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Cox Regression ◽

Standardized Uptake Value ◽

Small Cell ◽

Metabolic Parameters ◽

Small Cell Lung ◽

Predictive Values ◽

Pet Ct

Objectives: Increasing interests have been focused on using artificial intelligence (AI) to extend prognostic value of medical imaging. Feature extraction is a critical step for successful application of AI. The aim of this study was to explore several metabolic parameters measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) as potential AI features in predicting the effectiveness of chemotherapy in patients with non-small cell lung cancer (NSCLC). Methods: A set of metabolic parameters of PET/CT and clinical characteristics were detected from 137 patients with NSCLC treated with at least 1 cycle of chemotherapy. Survival receiver–operating characteristic (ROC) analysis was used to define the more significant parameters chosen for the following survival analysis. Patient survival was analyzed by Kaplan-Meier method, log-rank test, and Cox regression. Results: Survival ROC showed that maximum standardized uptake value (SUVmax), metabolic tumor volume 50% (MTV50), and total lesion glycolysis 50% (TLG50) had larger area under the curve, and the optimal cutoff values were 11.72, 4.04, and 34.55, respectively. Univariate and multivariate analyses synergistically showed that late PET/CT stage and MTV50 >4.04 were independent factors of poor survival in patients with NSCLC who received chemotherapy. Conclusions: Several potential prognostic biomarkers of PET/CT imaging have been extracted for predicting survival and selecting patients with NSCLC who are more likely to benefit from chemotherapy. The identification may accelerate the development of AI methods to improve treatment outcome for NSCLC.

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Comparison of characteristics and outcomes among veterans receiving first-line immunotherapy versus chemotherapy for stage IV non-small cell lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19295 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19295-e19295

Author(s):

Christina D Williams ◽

Lin Gu ◽

Vishal Vashistha ◽

Ashlyn Press ◽

Michael J. Kelley

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Clinical Characteristics ◽

Cox Regression ◽

Stage Iv ◽

Small Cell ◽

Small Cell Lung ◽

First Line ◽

Outpatient Visits

e19295 Background: Immunotherapy (IO) has revolutionized the treatment paradigm for patients with advanced non-small cell lung cancer (NSCLC). Study objectives were to evaluate utilization of IO as first-line (1L) therapy and compare clinical characteristics between patients receiving IO and those receiving CT in 1L setting. Methods: Using the U.S. Department of Veterans Affairs corporate data warehouse, patients with stage IV NSCLC diagnosed 2012-2017 and initiated non-targeted systemic therapy within 120 days of diagnosis were selected. Unadjusted descriptive statistics were used to compare patient characteristics, inpatient and outpatient clinic visits, and prevalence of select adverse events (AE) between patients receiving IO monotherapy and CT. Kaplan-Meier and Cox regression approaches with and without propensity score matching (PSM) were used for overall survival (OS) analyses. OS was calculated from treatment initiation date to death or end of study period in June 2019. Results: 4609 patients were included in the analysis: 3.4% (n = 156) received IO monotherapy, 96% (n = 4426) received CT, and 0.6% (n = 27) received IO+CT (IO+CT not included in analysis). IO patients were older than CT patients (median age 69 vs. 66 years, p < 0.0001) and more frequently resided in the Midwest and West regions whereas CT patients were more likely to live in the Northeast and South (p = 0.0024). There were no significant differences in IO and CT by other demographic and clinical characteristics. Estimated median OS was 7.5 months (95% CI 7.2-7.7) for CT and 7.9 months (95% CI 5.3-12.6) for IO patients. The unadjusted HR for IO compared to CT patients was 0.81 (95% CI 0.67-0.98). With 1:4 PSM (144 and 559 patients matched in the IO and CT groups, respectively), the HR was 0.75 (95% CI 0.60-0.93). The mean number of outpatient visits for IO and CT patients were 47 and 36, respectively (p = 0.003). No difference in number of hospitalizations or length of hospital stays between the two groups was observed. Common AEs in the IO group were dyspnea (58%), colitis/enterocolitis (42%), and anemia (30%). Common AEs among CT patients were colitis/enterocolitis (36%), anemia (32%), and nausea/vomiting (31%). Conclusions: In a real-world 1L setting among veterans with NSCLC, improvement in OS was observed among patients receiving IO monotherapy compared to those receiving CT, and IO patients had a greater number of outpatient visits. Continued assessment of treatment patterns and impact of IO are needed as the use of IO continues to expand.

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Noninvasive Evaluation of Microscopic Tumor Extensions Using Standardized Uptake Value and Metabolic Tumor Volume in Non-Small-Cell Lung Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2010.10.064 ◽

2012 ◽

Vol 82 (2) ◽

pp. 960-966 ◽

Cited By ~ 23

Author(s):

Xue Meng ◽

Xindong Sun ◽

Dianbin Mu ◽

Ligang Xing ◽

Li Ma ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Tumor Volume ◽

Standardized Uptake Value ◽

Metabolic Tumor Volume ◽

Small Cell ◽

Noninvasive Evaluation ◽

Small Cell Lung

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Evaluation of the factors affecting the maximum standardized uptake value of metastatic lymph nodes in different histological types of non-small cell lung cancer on PET-CT

BMC Pulmonary Medicine ◽

10.1186/s12890-015-0014-2 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 8

Author(s):

Yuehong Wang ◽

Shanni Ma ◽

Mengjie Dong ◽

Yake Yao ◽

Kanfeng Liu ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Nodes ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Standardized Uptake Value ◽

Small Cell ◽

Small Cell Lung ◽

Factors Affecting ◽

Maximum Standardized Uptake Value ◽

Pet Ct

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Prognostic impact of maximum standardized uptake value (SUVmax) of the primary lesion on survival in advanced non-small-cell lung cancer: A retrospective study

10.21203/rs.3.rs-41522/v1 ◽

2020 ◽

Author(s):

Xiaoling Qiu ◽

Hongge Liang ◽

Wei Zhong ◽

Jing Zhao ◽

Minjiang Chen ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Advanced Nsclc ◽

Standardized Uptake Value ◽

Lesion Size ◽

Lung Lesion ◽

Small Cell ◽

Small Cell Lung ◽

Pet Ct

Abstract Background: Positron emission tomography/computed tomography (PET/CT) has been widely recognized for diagnosing and staging lung cancer, but the prognostic value of standardized uptake value (SUV) in patients with advanced non-small-cell lung cancer (NSCLC) remains controversial. We aim to explore whether fluorodeoxyglucose uptake has prognostic significance in patients with advanced NSCLC. Methods: We performed a retrospective analysis of the data of patients with advanced NSCLC who had undergone PET/CT before systemic treatment between June 2012 and June 2016. The relationship between the SUV of the pulmonary lesion and lesion size was evaluated via Spearman’s correlation analysis. We collected patients’ clinical and pathological data. Univariate and multivariate analyses were performed to analyze the factors influencing survival.Results: Altogether, 157 patients with advanced NSCLC were included. Among these, 135 died, 13 survived, and 9 had incomplete data (median follow-up period of 69 months). SUV was correlated with lesion size and was significantly greater for tumors ≥3 cm than for tumors <3 cm (10.2±5.4 vs. 5.6±3.3, t=-6.709, p=0.000). Univariate analysis showed that survival was associated with gender, tumor size, epidermal growth factor receptor (EGFR) gene mutation, SUV of the primary lung lesion, and treatment line. Multivariate analysis showed a significant correlation between SUV of the primary lung lesion and survival. The mortality risk of patients with SUV ≤6 was 35% lower than that of patients with SUV >6 (95% CI 0.436-0.972, Wald value 4.400, p=0.036). Conclusions: The SUV of the primary lung lesion on PET/CT is significantly correlated with survival in previously untreated patients newly diagnosed with advanced NSCLC.

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