First-Line Pembrolizumab Mono- or Combination Therapy of Non-Small Cell Lung Cancer: Baseline Metabolic Biomarkers Predict Outcomes

First-Line Pembrolizumab Mono- or Combination Therapy of Non-Small Cell Lung Cancer: Baseline Metabolic Biomarkers Predict Outcomes

Quantitative biomarkers derived from positron-emission tomography/computed tomography (PET/CT) have been suggested as prognostic variables in immune-checkpoint inhibitor (ICI) treated non-small cell lung cancer (NSCLC). As such, data for first-line ICI therapy and especially for chemotherapy–ICI com...

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Bibliographic Details
Published in:Cancers Vol. 13; no. 23; p. 6096
Main Authors: Lang, David, Ritzberger, Linda, Rambousek, Vanessa, Horner, Andreas, Wass, Romana, Akbari, Kaveh, Kaiser, Bernhard, Kronbichler, Jürgen, Lamprecht, Bernd, Gabriel, Michael
Format: Journal Article
Language:English
Published: Basel MDPI AG 03-12-2021
MDPI
Subjects:
Biomarkers
Bone marrow
Bone tumors
Cancer therapies
Chemotherapy
Computed tomography
Cytotoxicity
Decision making
Disease control
Glycolysis
Immune checkpoint inhibitors
Immunosuppressive agents
Immunotherapy
Laboratories
Liver
Lung cancer
Lymphocytes
Medical imaging
Medical prognosis
Metabolism
Metastasis
Neutrophils
Non-small cell lung carcinoma
Patients
Pembrolizumab
Positron emission tomography
Prognosis
Proteins
Regression analysis
Small cell lung carcinoma
Spleen
Tomography
Tumors
Sweden
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Summary:Quantitative biomarkers derived from positron-emission tomography/computed tomography (PET/CT) have been suggested as prognostic variables in immune-checkpoint inhibitor (ICI) treated non-small cell lung cancer (NSCLC). As such, data for first-line ICI therapy and especially for chemotherapy–ICI combinations are still scarce, we retrospectively evaluated baseline 18F-FDG-PET/CT of 85 consecutive patients receiving first-line pembrolizumab with chemotherapy (n = 70) or as monotherapy (n = 15). Maximum and mean standardized uptake value, total metabolic tumor volume (MTV), total lesion glycolysis, bone marrow-/and spleen to liver ratio (BLR/SLR) were calculated. Kaplan–Meier analyses and Cox regression models were used to assess progression-free/overall survival (PFS/OS) and their determinant variables. Median follow-up was 12 months (M; 95% confidence interval 10–14). Multivariate selection for PFS/OS revealed MTV as most relevant PET/CT biomarker (p < 0.001). Median PFS/OS were significantly longer in patients with MTV ≤ 70 mL vs. >70 mL (PFS: 10 M (4–16) vs. 4 M (3–5), p = 0.001; OS: not reached vs. 10 M (5–15), p = 0.004). Disease control rate was 81% vs. 53% for MTV ≤/> 70 mL (p = 0.007). BLR ≤ 1.06 vs. >1.06 was associated with better outcomes (PFS: 8 M (4–13) vs. 4 M (3–6), p = 0.034; OS: 19 M (12-/) vs. 6 M (4–12), p = 0.005). In patients with MTV > 70 mL, concomitant BLR ≤ 1.06 indicated a better prognosis. Higher MTV is associated with inferior PFS/OS in first-line ICI-treated NSCLC, with BLR allowing additional risk stratification.
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ISSN:2072-6694
2072-6694
DOI:10.3390/cancers13236096