Therapeutic Advances in Medical Oncology (Jan 2022)

Predicting treatment outcomes using F-FDG PET biomarkers in patients with non-small-cell lung cancer receiving chemoimmunotherapy

  • Chang Gon Kim,
  • Sang Hyun Hwang,
  • Kyung Hwan Kim,
  • Hong In Yoon,
  • Hyo Sup Shim,
  • Ji Hyun Lee,
  • Yejeong Han,
  • Beung-Chul Ahn,
  • Min Hee Hong,
  • Hye Ryun Kim,
  • Byoung Chul Cho,
  • Arthur Cho,
  • Sun Min Lim

DOI
https://doi.org/10.1177/17588359211068732
Journal volume & issue
Vol. 14

Abstract

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Background: Predictive markers for treatment response and survival outcome have not been identified in patients with advanced non-small-cell lung cancer (NSCLC) receiving chemoimmunotherapy. We aimed to evaluate whether imaging biomarkers of 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) and routinely assessed clinico-laboratory values were associated with clinical outcomes in patients with advanced NSCLC receiving pembrolizumab plus platinum-doublet chemotherapy as a first-line treatment. Methods: We retrospectively enrolled 52 patients with advanced NSCLC who underwent baseline 18 F-FDG PET/CT before treatment initiation. PET/CT parameters and clinico-laboratory variables, constituting the prognostic immunotherapy scoring system, were collected. Optimal cut-off values for PET/CT parameters were determined using the maximized log-rank test for progression-free survival (PFS). A multivariate prediction model was developed based on Cox models for PFS, and a scoring system was established based on hazard ratios of the predictive factors. Results: During the median follow-up period of 16.7 months (95% confidence interval: 15.7–17.7 months), 43 (82.7%) and 31 (59.6%) patients experienced disease progression and death, respectively. Objective response was observed in 23 (44.2%) patients. In the multivariate analysis, maximum standardized uptake value, metabolic tumour volume 2.5 , total lesion glycolysis 2.5 , and bone marrow-to-liver uptake ratio from the PET/CT variables and neutrophil-to-lymphocyte ratio (NLR) from the clinico-laboratory variables were independently associated with PFS. The scoring system based on these independent predictive variables significantly predicted the treatment response, PFS, and overall survival. Conclusion: PET/CT variables and NLR were useful biomarkers for predicting outcomes of patients with NSCLC receiving pembrolizumab and chemotherapy as a first-line treatment, suggesting their potential as effective markers for combined PD-1 blockade and chemotherapy.