Early Evaluation of Immunotherapy Response in Lymphoma Patients by 18F-FDG PET/CT: A Literature Overview

Immunotherapy is a promising therapeutic strategy both for solid and hematologic tumors, such as in Hodgkin (HL) and non-Hodgkin lymphoma (NHL). In particular, immune-checkpoint inhibitors, such as nivolumab and pembrolizumab, are increasingly used for the treatment of refractory/relapsed HL. At the same time, evidence of chimeric antigen receptor (CAR)-T-cell immunotherapy efficacy mostly in NHL is growing. In this setting, the challenge is to identify an appropriate imaging method to evaluate immunotherapy response. The role of 18F-Fluorodeoxyglucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT), especially in early evaluation, is under investigation in order to guide therapeutic strategies, taking into account the possible atypical responses (hyperprogression and pseudoprogression) and immune-related adverse events that could appear on PET images. Herein, we aimed to present a critical overview about the role of 18F-FDG PET/CT in evaluating treatment response to immunotherapy in lymphoma patients.

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Hyperprogressive Disease in Patients with Non–Small Cell Lung Cancer Treated with Checkpoint Inhibitors: The Role of 18F-FDG PET/CT

Journal of Nuclear Medicine ◽

10.2967/jnumed.119.237768 ◽

2019 ◽

Vol 61 (6) ◽

pp. 821-826 ◽

Cited By ~ 14

Author(s):

Angelo Castello ◽

Sabrina Rossi ◽

Emanuela Mazziotti ◽

Luca Toschi ◽

Egesta Lopci

Keyword(s):

Lung Cancer ◽

Fdg Pet ◽

Checkpoint Inhibitors ◽

Small Cell ◽

Small Cell Lung ◽

Pet Ct ◽

18F Fdg ◽

Hyperprogressive Disease ◽

Fdg Pet Ct

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Role of 2-[18F]FDG as a Radiopharmaceutical for PET/CT in Patients with COVID-19: A Systematic Review

Pharmaceuticals ◽

10.3390/ph13110377 ◽

2020 ◽

Vol 13 (11) ◽

pp. 377

Author(s):

Salvatore Annunziata ◽

Roberto C. Delgado Bolton ◽

Christel-Hermann Kamani ◽

John O. Prior ◽

Domenico Albano ◽

...

Keyword(s):

Systematic Review ◽

Positron Emission Tomography ◽

Fdg Pet ◽

Emission Tomography ◽

Evidence Based ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Some recent studies evaluated the role of fluorine-18 fluorodeoxyglucose (2-[18F]FDG) as a radiopharmaceutical for positron emission tomography/computed tomography (PET/CT) imaging in patients with Coronavirus Disease (COVID-19). This article aims to perform a systematic review in this setting. A comprehensive computer literature search in PubMed/MEDLINE and Cochrane library databases regarding the role of 2-[18F]FDG PET/CT in patients with COVID-19 was carried out. This combination of key words was used: (A) “PET” OR “positron emission tomography” AND (B) “COVID” OR “SARS”. Only pertinent original articles were selected; case reports and very small case series were excluded. We have selected 11 original studies of 2-[18F]FDG PET/CT in patients with COVID-19. Evidence-based data showed first preliminary applications of this diagnostic tool in this clinical setting, with particular regard to the incidental detection of interstitial pneumonia suspected for COVID-19. To date, according to evidence-based data, 2-[18F]FDG PET/CT cannot substitute or integrate high-resolution CT to diagnose suspicious COVID-19 or for disease monitoring, but it can only be useful to incidentally detect suspicious COVID-19 lesions in patients performing this imaging method for standard oncological and non-oncological indications. Published data about the possible role of 2-[18F]FDG PET/CT in patients with COVID-19 are increasing, but larger studies are warranted.

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Soluble PD-L1 in NSCLC Patients Treated with Checkpoint Inhibitors and Its Correlation with Metabolic Parameters

Cancers ◽

10.3390/cancers12061373 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1373 ◽

Cited By ~ 2

Author(s):

Angelo Castello ◽

Sabrina Rossi ◽

Luca Toschi ◽

Luigi Mansi ◽

Egesta Lopci

Keyword(s):

Fdg Pet ◽

Tumor Volume ◽

Checkpoint Inhibitors ◽

Metabolic Parameters ◽

Cell Lung Carcinoma ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Nsclc Patients

We investigated the role of soluble PD-L1 (sPD-L1) in non-small cell lung carcinoma (NSCLC) patients treated with immune checkpoint inhibitors (ICI) and analyzed its association with clinical outcomes and metabolic parameters by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT). Between July 2017 and May 2019, we enrolled 20 candidate patients of ICI therapy who had serum frozen samples and 18F-FDG PET/CT available, both at baseline and at the first response evaluation. This analysis is embedded into a larger prospective study (NCT03563482). Twelve out of 20 patients received nivolumab, one patient received combination of nivolumab and ipilimumab, whereas the others received pembrolizumab. Median sPD-L1 level at baseline was 27.22 pg/mL. We found a significant association between patients with elevated sPD-L1, above the median value, and high metabolic tumor burden, expressed by metabolic tumor volume (MTV, 115.3 vs. 35.5, p = 0.034) and total lesion glycolysis (TLG, 687 vs. 210.1, p = 0.049). At the first restaging after 7–8 weeks, median sPD-L1 levels significantly increased as compared to baseline median value (43.9 pg/mL, p = 0.017). No significant differences in response rates were detected, according to both morphological and metabolic response criteria. Likewise, no difference in survival outcomes were observed between low sPD-L1 and high sPD-L1 patients. The increase of sPD-L1 concentrations during ICI treatment may reflect the expansion of tumor volume and the tumor lysis. Moreover, it is supposed that sPD-L1 has its own biological action, either by reducing membrane PD-1 sites available for nivolumab or by inducing lymphocytes exhaustion after binding their membrane PD-1. Further, larger studies are needed to confirm our preliminary results on the role of sPD-L1 during ICI therapy.

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Faculty Opinions recommendation of Prosthetic vascular graft infection: the role of 18F-FDG PET/CT.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1089552.544806 ◽

2007 ◽

Author(s):

Barry Shulkin

Keyword(s):

Fdg Pet ◽

Vascular Graft ◽

Graft Infection ◽

Vascular Graft Infection ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Prosthetic Vascular Graft Infection

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Faculty Opinions recommendation of Fever of unknown origin: the role of 18F-FDG PET/CT.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1138076.595192 ◽

2008 ◽

Author(s):

Barry Shulkin

Keyword(s):

Fdg Pet ◽

Fever Of Unknown Origin ◽

Unknown Origin ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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The Role of 18F-FDG PET/CT in Follow up After Treatment in Childhood Langerhans Cell Histiocytosis.

The Egyptian Journal Nuclear Medicine ◽

10.21608/egyjnm.2019.106661 ◽

2019 ◽

Vol 19 (2) ◽

pp. 50-63

Author(s):

Ismail, A ◽

Abdel Gaid, S.

Keyword(s):

Fdg Pet ◽

Langerhans Cell Histiocytosis ◽

Langerhans Cell ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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The Role of PET/CT in the Era of Immune Checkpoint Inhibitors: State of Art

Current Radiopharmaceuticals ◽

10.2174/1874471012666191015100106 ◽

2020 ◽

Vol 13 (1) ◽

pp. 24-31 ◽

Cited By ~ 2

Author(s):

Angelo Castello ◽

Egesta Lopci

Keyword(s):

Immune Checkpoint ◽

Checkpoint Inhibitors ◽

Evaluation Criteria ◽

Advanced Melanoma ◽

Response Criteria ◽

Response Evaluation ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Background: Immune checkpoint inhibitors (ICI) have achieved astonishing results and improved overall survival (OS) in several types of malignancies, including advanced melanoma. However, due to a peculiar type of anti-cancer activity provided by these drugs, the response patterns during ICI treatment are completely different from that with “old” chemotherapeutic agents. Objective: To provide an overview of the available literature and potentials of 18F-FDG PET/CT in advanced melanoma during the course of therapy with ICI in the context of treatment response evaluation. Methods: Morphologic criteria, expressed by Response Evaluation Criteria in Solid Tumors (RECIST), immune-related response criteria (irRC), irRECIST, and, more recently, immune-RECIST (iRECIST), along with response criteria based on the metabolic parameters with 18F-Fluorodeoxyglucose (18FFDG), have been explored. Results: To overcome the limits of traditional response criteria, new metabolic response criteria have been introduced on time and are being continuously updated, such as the PET/CT Criteria for the early prediction of Response to Immune checkpoint inhibitor Therapy (PECRIT), the PET Response Evaluation Criteria for Immunotherapy (PERCIMT), and “immunotherapy-modified” PET Response Criteria in Solid Tumors (imPERCIST). The introduction of new PET radiotracers, based on monoclonal antibodies combined with radioactive elements (“immune-PET”), are of great interest. Conclusion: Although the role of 18F-FDG PET/CT in malignant melanoma has been widely validated for detecting distant metastases and recurrences, evidences in course of ICI are still scarce and larger multicenter clinical trials are needed.

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