Dynamic 18F‐FDG PET/CT can predict the major pathological response to neoadjuvant immunotherapy in non‐small cell lung cancer

• Published in: Thoracic cancer 2022-09, Vol.13 (17), p.2524-2531
• Main Authors: Chen, Zhi‐Yong, Fu, Rui, Tan, Xiao‐Yue, Yan, Li‐Xu, Tang, Wen‐Fang, Qiu, Zhen‐Bin, Qi, Yi‐Fan, Li, Yu‐Fa, Hou, Qing‐Yi, Wu, Yi‐Long, Zhong, Wen‐Zhao, Jiang, Ben‐Yuan
• Format: Article
• Language: English
• Subjects: 18F‐FDG PET/CT; Brief Report; Cancer therapies; Chemotherapy; Immunotherapy; Lung cancer; major pathological response; Medical imaging; neoadjuvant therapy; non‐small cell lung cancer; Patients; Surgery; Tomography; Tumors
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.14562

Major pathological response (MPR) is a potential surrogate for overall survival. We determined whether the dynamic changes in 18F‐labeled fluoro‐2‐deoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT) were associated with MPR in patients receiving neoadjuvant immunotherapy. Forty‐four patients with stage II–III non‐small cell lung cancer (NSCLC) who received neoadjuvant immunotherapy and radical surgery were enrolled. Moreover, 18F‐FDG PET/CT scans were performed at baseline and within 1 week before surgery to evaluate the disease. All histological sections were reviewed to assess MPR. The detailed clinical features of the patients were analyzed. The reliability of the clinical variables was assessed in differentiating between MPR and non‐MPR using logistic regression. Receiver‐operating characteristic (ROC) curve analysis identified the SUVmax changes threshold most associated with MPR. Most of the patients were pathologically diagnosed with squamous cell carcinoma and received anti‐PD‐1 antibodies plus chemotherapy. The immunotherapy regimens included nivolumab, pembrolizumab, and camrelizumab. MPR was observed in more than half of lesions. Tumors with MPR had a higher decrease in the longest dimension on dynamic PET/CT than those without MPR. Furthermore, the decline in SUVmax was significantly different between MPR and non‐MPR diseases, and MPR lesions had a prominent mean reduction in SUVmax. SUVmax reduction was independently associated with MPR in the multivariate regression. On ROC analysis, the threshold of SUVmax decrease in 60% was associated with MPR. Dynamic changes in SUVmax were associated with MPR. The tumors with MPR showed a greater PET/CT response than those without MPR. A SUVmax decrease of more than 60% is more likely to result in an MPR after receiving neoadjuvant immunotherapy. It is not clear whether the features of 18F‐FDG PET/CT between the patients with MPR and without MPR who receive preoperative immunotherapy are different. In this study, we found that the decline of SUVmax in dynamic 18F‐FDG PET/CT were significantly different between MPR and non‐MPR groups. A SUVmax decrease of more than 60% is more likely to result in an MPR. Dynamic 18F‐FDG PET/CT was important to evaluate the clinical response of preoperative immunotherapy and determined the potential beneficial population from neoadjuvant immunotherapy.