Metabolic activity by 18F–FDG-PET/CT is predictive of early response after nivolumab in previously treated NSCLC
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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.
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.
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.
Metabolic response by 18F–FDG was effective in predicting efficacy and survival at 1 month after nivolumab treatment.
KeywordsFDG-PET Nivolumab Pd-L1 Lung cancer Early response
We thank Ms. Yuka Matsui for her technical assistance during the manuscript submission. We deeply appreciate the help provided by Ms. Yoko Tokumitsu of the Department of Outpatient Chemotherapy Center, Hidaka Hospital, Drs. Toshitaka Maeno, Kenichiro Hara, Yasuhiko Koga, and Akira Ono of the Department of Respiratory Medicine, and Drs. Toshiki Yajima and Takayuki Kosaka of the Department of Respiratory Surgery, Gunma University Hospital, for data collection and clinical advice.
Compliance with ethical standards
Conflict of interest
KK has received research grants and speaker honoraria from Ono Pharmaceutical Company and Bristol-Myers Company. All remaining authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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