FDG-PET/CT and CT Compared for Evaluation of Tumor Response to First-Line Immunotherapy and Prediction of Prognosis in Non-Small-Cell Lung Cancer Patients

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INTRODUCTION: Immunotherapy-modified Positron Emission Tomography Response Criteria in Solid Tumors (imPERCIST) using FDG-PET/CT and immune-related Response Evaluation Criteria in Solid Tumors (irRECIST) using CT were compared for evaluation of response, prognosis prediction, and effect on patient management in non-small-cell lung cancer (NSCLC) patients treated with first-line immunotherapy, or immunotherapy and chemotherapy combined. METHODS: Thirty-three patients (26 males, median 68.0 years old) with histologically NSCLC without EGFR/ALK/KRAS alterations underwent pembrolizumab treatment only or immunotherapy combined with chemotherapy. FDG-PET/CT and diagnostic CT scanning was performed at the baseline and after two to four cycles (2 in 8, 3 in 12, 4 in 13 patients). Findings for therapeutic response obtained with imPERCIST and irRECIST were compared. Progression-free survival (PFS) and overall survival (OS) were examined using log-rank and Cox methods. RESULTS: imPERCIST indicated that 10 patients had complete metabolic response (CMR), eight partial metabolic response (PMR), three stable metabolic disease (SMD), and 12 progressive metabolic disease (PMD), while irRECIST showed that two had complete response (CR), 14 PR, nine SD, and eight PD, indicating substantial concordance (κ = 0.615). Twenty-eight patients showed progression and 18 died from NSCLC after a median 16.2 months. Patients showing response based on imPERCIST and irRECIST (CMR/PMR, CR/PR, respectively) showed significantly longer PFS and OS than nonresponders (SMD/PMD, SD/PD, respectively) (imPERCIST: p < 0.0001 and p = 0.0001, respectively; irRECIST: p = 0.0018 and p = 0.011, respectively). imPERCIST resulted in a change of management in 12 of the 33 patients (36.3%) with an additional effect on patient management in 4 patients (12.1%) evaluated by irRECIST. CONCLUSION: For evaluation of NSCLC patients for tumor response and patient management following first-line immunotherapy or that combined with chemotherapy, and predicting prognosis, both FDG-PET/CT and CT findings are accurate, with FDG-PET/CT being superior.

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