Advertisement

Lung Cancer: 18F-FDG PET/CT for Response Assessment of Lung Following Immunotherapy

  • Laura EvangelistaEmail author
  • Giulia Pasello
Chapter

Abstract

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.

Keywords

Lung cancer Breast cancer Immunotherapy Nivolumab Durvalumab FDG PET/CT Computed tomography RECIST Response to therapy 

References

  1. 1.
    Li J, Xu W, Kong F, Sun X, Zuo X. Meta-analysis: accuracy of 18FDG PET-CT for distant metastasis staging in lung cancer patients. Surg Oncol. 2013;22:151–5.CrossRefGoogle Scholar
  2. 2.
    Qu X, Huang X, Yan W, Wu L, Dai K. A meta-analysis of 18FDGPET-CT, 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with lung cancer. Eur J Radiol. 2012;81:1007–15.CrossRefGoogle Scholar
  3. 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. 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
  5. 5.
    Grizzi F, Castello A, Lopci E. Is it time to change our vision of tumor metabolism prior to immunotherapy? Eur J Nucl Med Mol Imaging. 2018;45:1072–5.CrossRefGoogle Scholar
  6. 6.
    Chiou VL, Burotto M. Pseudoprogression and immune-related response in solid tumors. J Clin Oncol. 2015;33:3541–3.CrossRefGoogle Scholar
  7. 7.
    Ciarmiello A, Fonti R, Giovacchini G, Del Vecchio S. Imaging of immunotherapy response in non-small cell lung cancer: challenges and perspectives. Clin Transl Imaging. 2018;6:483–5.CrossRefGoogle Scholar
  8. 8.
    Kaira K, Higuchi T, Naruse I, Arisaka Y, Tokue A, Altan B, et al. Metabolic activity by 18F-FDG-PET/CT is predictive of early response after nivolumab in previously treated NSCLC. Eur J Nucl Med Mol Imaging. 2018;45:56–66.CrossRefGoogle Scholar
  9. 9.
    Higuchi M, Owada Y, Inoue T, Watanabe Y, Yamaura T, Fukuhara M, et al. FDG-PET in the evaluation of response to nivolumab in recurrent non-small-cell lung cancer. World J Surg Oncol. 2016;14:238.CrossRefGoogle Scholar
  10. 10.
    Curioni-Fontecedro A, Ickenberg C, Franzen D, Rogler G, Burger IA, van den Broek. Diffuse pseudoprogression in a patient with metastastic non-small-cell-lung-cancer treated with nivolumab. Ann Oncol. 2017;28:2040.CrossRefGoogle Scholar
  11. 11.
    Caulo A, Mirsadraee S, Maggi F, Leccisotti L, van Beek EJ, Bonomo L. Integrated imaging of non-small cell lung cancer recurrence: CT and PET-CT findings, possible pitfalls and risk of recurrence criteria. Eur Radiol. 2012;22:588–606.CrossRefGoogle Scholar
  12. 12.
    Gorenberg M, Bar-Shalom R, Israel O. Patterns of FDG uptake in post-thoracotomy surgical scars in patients with lung cancer. Br J Radiol. 2008;81:821–5.CrossRefGoogle Scholar
  13. 13.
    NSCLC Meta-analysis Collaborative Group. Preoperative chemotherapy for non-small-cell lung cancer: a systematic review and meta-analysis of individual participant data. Lancet. 2014;383:1561–71.CrossRefGoogle Scholar
  14. 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
  15. 15.
    Emens LA, Kok M, Ojalvo LS. Targeting the programmed cell death-1 pathway in breast and ovarian cancer. Curr Opin Obstet Gynecol. 2016;28:142–7.CrossRefGoogle Scholar
  16. 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
  17. 17.
    Cimino-Mathews A, Thompson E, Taube JM, Ye X, Lu Y, Meeker A, Xu H, et al. PD-L1 (B7-H1) expression and the immune tumor microenvironment in primary and metastatic breast carcinomas. Hum Pathol. 2016;47:52–63.CrossRefGoogle Scholar
  18. 18.
    Nanda R, Chow LQ, Dees EC, Berger R, Gupta S, Geva R, et al. Pembrolizumab in patients with advanced triple-negative breast cancer: Phase Ib KEYNOTE-012 study. J Clin Oncol. 2016;34:2460–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Nuclear Medicine and Molecular Imaging UnitVeneto Institute of Oncology IOV—IRCCSPaduaItaly
  2. 2.Oncology 2 UnitVeneto Institute of Oncology IOV—IRCCSPaduaItaly

Personalised recommendations