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Prospective Assessment of Fluorine-18-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography

Sif Homburg1, Charlotte Birk Christensen2, Magnus Pedersen3

  • 1Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark.

Cancers
|March 13, 2024
PubMed

Insights

Dual-time point FDG-PET/CT scans show limited ability to distinguish pseudoprogression from disease progression in metastatic melanoma patients treated with immune checkpoint inhibitors. PERCIMT criteria may offer complementary value in clinical decision-making.

Area of Science:

  • Oncology
  • Radiology
  • Immunotherapy

Background:

  • Immune checkpoint inhibitors (ICIs) are crucial for metastatic melanoma treatment.
  • Monitoring treatment response with FDG-PET/CT is challenged by distinguishing disease progression (PD) from pseudoprogression (PsPD).
  • PsPD can manifest as increased FDG uptake due to immune cell infiltration, mimicking tumor growth.

Purpose of the Study:

  • To prospectively evaluate the efficacy of dual-time point (DTP) FDG-PET/CT compared to PERCIMT criteria in differentiating PsPD from PD.
  • To assess the diagnostic performance of these methods in patients with metastatic melanoma receiving ICIs.

Main Methods:

  • Prospective study including 41 patients with suspected PsPD on initial evaluation.
  • Subsequent DTP FDG-PET/CT scans within 14 days, followed by confirmatory scans.
  • Application of modified PERCIMT criteria for response assessment.

Main Results:

  • DTP FDG-PET/CT identified 24% PsPD and 76% PD; PERCIMT criteria identified 69% PsPD and 31% PD.
  • Confirmatory follow-up revealed 34% confirmed PsPD and 66% confirmed PD.
  • Sensitivity/specificity for DTP FDG-PET/CT: 20%/74%; for PERCIMT: 80%/37%.

Conclusions:

  • DTP FDG-PET/CT demonstrates limited efficacy in differentiating PsPD from PD in ICI-treated metastatic melanoma.
  • PERCIMT criteria show potential as a complementary tool for clinical assessment.
  • Integration into multidisciplinary team conferences may enhance treatment decision-making for these patients.
Keywords:
FDG-PET/CTPERCIMTdual-time point FDG-PET/CTimmune checkpoint inhibitorsmetastatic melanomapseudoprogression

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