Prognostic value of baseline metabolic tumor volume measured on 18F-fluorodeoxyglucose positron emission tomography/computed tomography in melanoma patients treated with ipilimumab therapy
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Ipilimumab induces durable remission in about 15–20% of patients with metastatic melanoma. However, reliable predictors of response to ipilimumab are currently lacking. Whole-body metabolic tumor volume (wMTV) has been shown to be a strong prognostic factor in a variety of malignancies treated with chemotherapy, but few results have been reported for patients treated with immunotherapy. The purpose of this study was to investigate the prognostic value of wMTV and other metabolic parameters from baseline 18F-FDG PET/CT scans in patients with melanoma being treated with ipilimumab.
The prognostic impact of wMTV, as well as mean standardized uptake values and total lesion glycolysis, was evaluated in 142 consecutive patients with melanoma treated with single-agent ipilimumab therapy. Metabolic parameters were dichotomized by their respective medians and correlated with overall survival (OS). In addition, the prognostic value of metabolic parameters combined with known clinical prognostic factors was evaluated in multivariate analyses.
The median OS time in all patients was 14.7 months (95% CI 10.45–18.93 months). wMTV was a strong independent prognostic factor for OS (p = 0.001). The median survival in patients with a metabolic volume above the median was 10.8 months (95% CI 5.88–15.81 months) as compared with 26.0 months (95% CI 3.02–49.15 months) in patients with an MTV below the median. A multivariate model including wMTV and known clinical prognostic factors, such as age and the presence of brain metastases, further improved the identification of patient subgroups with different OS times.
wMTV appears to be a strong independent prognostic factor in melanoma patients treated with ipilimumab, and can be determined semiautomatically from routine 18F- FDG PET/CT scans. wMTV, combined with clinical prognostic factors, could be used to personalize immunotherapy and in future clinical studies.
KeywordsCTLA-4 Metabolic tumor volume Ipilimumab Melanoma PET
This work was funded in part by NIH/NCI Cancer Center Support Grant (P30 CA008748).
Compliance with ethical standards
Conflicts of interest
Dr. Jedd Wolchok: serves as a consultant for Adaptive Biotech, Advaxis; Amgen, Apricity, Array BioPharma, Ascentage Pharma, Astellas, Beigene, Bristol Myers Squibb, Celgene, Chugai, Elucida, Eli Lilly, F Star, Genentech, Imvaq, Kleo Pharma, MedImmune, Merck, Neon Therapeutics, Ono, Polaris Pharma, Polynoma, Psioxus, Puretech, Recepta, Trienza, Sellas Life Sciences, Serametrix, Surface Oncology, and Syndax; has received research support: from Bristol Myers Squibb, Medimmune, Merck Pharmaceuticals, and Genentech; and has equity in Potenza Therapeutics, Tizona Pharmaceuticals, Adaptive Biotechnologies, Elucida, Imvaq, Beigene, and Trieza. Dr. Wolfgang Weber: has received research support from Ipsen, Piramal, Blue Earth Diagnostics, and Bristol-Myers Squibb; and has served as a consultant for Progenics Pharmaceuticals Inc., Endocyte, Merck, Bayer, and Blue Earth Diagnostics. All other authors declare that they have no conflicts of interest.
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