Lung Cancer: 18F-FDG PET/CT for Response Assessment of Lung Following Immunotherapy
Immunotherapy has been recently introduced in clinical practice for the treatment of lung cancer. The current experiences have demonstrated a significant advantage in terms of overall survival, by using these new approaches. However, new clinical trials are now available for testing the utility of immunotherapy in other thoracic tumors, like thymoma, pleural mesothelioma, and breast cancer. To date, contrast-enhanced computed tomography (ceCT) represents the imaging of choice for monitoring the response to therapy in patients treated with immune check point inhibitors, although its performance is reduced by the appearance of pseudoprogression or hyperprogression. Moreover, conventional anatomical criteria for the assessment of response to therapy are not optimal for the immune check point inhibitors. 18F-Fluorodeoxyglucose positron emission tomography (PET/CT) has been widely used in lung cancer and for the evaluation of an early response to treatment, but its role during immunotherapy is still debated. However, its advantages should be addressed in thorax cancer, both during and after immunotherapy. In this chapter, we have made a collation of 18F-FDG PET/CT scans of patients affected by breast cancer and lung cancer, scheduled for immunotherapy, or of those evaluated after the end of treatment with immune check point inhibitors.
KeywordsLung cancer Breast cancer Immunotherapy Nivolumab Durvalumab FDG PET/CT Computed tomography RECIST Response to therapy
- 3.Liu T, Xu J-Y, Xu W, Bai Y-R, Yan W-L, Yang H-L. Fluorine-18 deoxyglucose positron emission tomography, magnetic resonance imaging and bone scintigraphy for the diagnosis of bone metastases in patients with lung cancer: which one is the best?—a meta-analysis. Clin Oncol. 2011;23:350–8.CrossRefGoogle Scholar
- 4.Lopci E, Toschi L, Grizzi F, Rahal D, Olivari L, Castino GF, et al. Correlation of metabolic information on FDG-PET with tissue expression of immune markers in patients with non-small cell lung cancer (NSCLC) who are candidates for upfront surgery. Eur J Nucl Med Mol Imaging. 2016;43:1954–61.CrossRefGoogle Scholar
- 14.Kerner GSMA, Koole MJB, Bongaerts AHH, Pruim J, Groen HJM, CTMM Air Force Consortium. Total body metabolic tumor response in ALK positive non-small cell lung cancer patients treated with ALK inhibition. PLoS One. 2016;11(5):e0149955. https://doi.org/10.1371/journal.pone.0149955.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Rugo H, DeLord J-P, Im S-A, Ott PA, Piha-Paul SA, Bedard PI, et al. Preliminary efficacy and safety of pembrolizumab (MK-3475) in patients with PD-L1 positive, estrogen receptor (ER)-positive(ER+)/HER-2 negative breast cancer enrolled in KEYNOTE-028 (abstract). In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium; 2015 Dec 8–12: San Antonio, TX. Philadelphia (PA): AACR; Cancer Res. 2016;76(4 Suppl): Abstract nr S05-07.Google Scholar