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Imaging Characteristics and Diagnostic Performance of 2-deoxy-2-[18F]fluoro-d-Glucose PET/CT for Melanoma Patients Who Demonstrate Hyperprogressive Disease When Treated with Immunotherapy

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Abstract

Purpose

We investigated the ability of baseline 2-deoxy-2-[18F]fluoro-d-glucose PET/CT parameters, acquired before the start of immunotherapy, to predict development of hyperprogressive disease (HPD) in melanoma patients. We also evaluated the diagnostic performances of ratios of baseline and first restaging PET/CT parameters to diagnose HPD without information of the tumor growth kinetic ratio (TGKR) that requires pre-baseline imaging before baseline imaging (3 timepoint imaging).

Procedures

Seventy-six patients who underwent PET/CT before and approximately 3 months following initiation of immunotherapy were included. PET/CT parameters, including metabolic tumor volume (MTV) for all melanoma lesions and total measured tumor burden (TMTB) based on irRECIST, were measured from baseline PET/CT (MTVbase and TMTBbase) and first restaging PET/CT (MTVpost and TMTBpost). The ratios of MTV (MTVpost/MTVbase, MTVr) and TMTB (TMTBpost/TMTBbase, TMTBr) were calculated.

Results

MTVbase of HPD patients (n = 9, TGKR ≥ 2) was larger than that of non-HPD (n = 67, TGKR < 2) patients (P < 0.05), and HPD patients demonstrated shorter median overall survival (7 vs. more than 60 months, P < 0.05). The area under the curve (AUC) of MTVbase (≥ 155.5 ml) to predict the risk of HPD was 0.703, with a sensitivity of 66.7 % and specificity of 81.2 %. The AUCs of MTVr (≥ 1.25) and TMTBr (≥ 1.27) to diagnose HPD without information of TGKR were 0.875 and 0.977 with both sensitivities of 100 %, and specificities of 79 % and 83.9 %, respectively.

Conclusions

Patients at high risk of developing HPD could not be accurately identified based on baseline PET/CT parameters. The ratios of baseline and first restaging PET/CT parameters may be helpful to diagnose HPD, when patients do not undergo pre-baseline imaging.

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Authors and Affiliations

  1. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5281, USA

    Ryusuke Nakamoto, Jarrett Rosenberg, Valentina Ferri, Guido Davidzon, Carina Mari Aparici, Judy Nguyen, Farshad Moradi, Andrei Iagaru & Benjamin Lewis Franc

  2. Department of Dermatology, Stanford University, Stanford, CA, USA

    Lisa C Zaba

  3. Department of Oncology, Stanford University, Stanford, CA, USA

    Sunil Arani Reddy

  4. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, USA

    Tomomi W Nobashi

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  1. Ryusuke Nakamoto
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Correspondence to Ryusuke Nakamoto.

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The Institutional Review Board approved this retrospective study and waived the requirement for obtaining written informed consent.

Conflict of Interest

Andrei Iagaru receives institutional research support from GE Healthcare, Advanced Accelerator Applications, and Progenics Pharmaceuticals, unrelated to this work. The other authors declare that they have no conflict of interest.

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Nakamoto, R., C Zaba, L., Rosenberg, J. et al. Imaging Characteristics and Diagnostic Performance of 2-deoxy-2-[18F]fluoro-d-Glucose PET/CT for Melanoma Patients Who Demonstrate Hyperprogressive Disease When Treated with Immunotherapy. Mol Imaging Biol 23, 139–147 (2021). https://doi.org/10.1007/s11307-020-01526-4

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