[¹⁸F]FDG PET/CT for predicting neoadjuvant PD-L1 blockade monotherapy treatment response in patients with locally advanced esophageal squamous cell carcinoma: a preliminary study

Runjun Yang ^1,2,3,4, Han Tang ^4,5, Yunze Xie ^1,2,3,4

¹Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180 in Fenglin Road, Shanghai, 200032, P.R. China.
²Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
³Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.
⁴Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
⁵Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180 in Fenglin Road, Shanghai, 200032, P.R. China.
⁶Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. Tan.lijie@zs-hospital.sh.cn.
⁷Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, No. 180 in Fenglin Road, Shanghai, 200032, P.R. China. Tan.lijie@zs-hospital.sh.cn.
⁸Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180 in Fenglin Road, Shanghai, 200032, P.R. China. shi.hongcheng@zs-hospital.sh.cn.
⁹Shanghai Institute of Medical Imaging, Shanghai, 200032, China. shi.hongcheng@zs-hospital.sh.cn.
¹⁰Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China. shi.hongcheng@zs-hospital.sh.cn.
¹¹Cancer Prevention and Treatment Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. shi.hongcheng@zs-hospital.sh.cn.

⁰Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180 in Fenglin Road, Shanghai, 200032, P.R. China.

European Journal of Nuclear Medicine and Molecular Imaging +

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January 1, 2025

View abstract on PubMed

Summary

18F-FDG PET/CT metabolic parameters effectively predict treatment response in locally advanced esophageal squamous cell carcinoma (LA-ESCC) patients receiving neoadjuvant PD-L1 blockade. Changes in metabolic tumor volume and total lesion glycolysis show promise for personalized immunotherapy.

Area Of Science

Oncology
Nuclear Medicine
Radiomics

Background

Locally advanced esophageal squamous cell carcinoma (LA-ESCC) presents a significant therapeutic challenge.
Neoadjuvant programmed death-ligand 1 (PD-L1) blockade offers a promising treatment strategy.
Accurate prediction of treatment response is crucial for optimizing patient management.

Purpose Of The Study

To evaluate the predictive capability of 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) PET/CT for assessing primary tumor (PT) and lymph node (LN) responses.
To determine the value of FDG PET/CT in patients with LA-ESCC undergoing neoadjuvant PD-L1 blockade monotherapy.

Main Methods

A single-arm phase 1b clinical trial (NATION-1907) involving 23 LA-ESCC patients treated with Adebrelimab and surgery.
18F-FDG PET/CT scans were performed before immunotherapy and before surgery.
Standardized uptake value corrected for lean body mass (SUL)-derived parameters, including SULmax and SULpeak, were analyzed for PTs and LNs. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were calculated using European Association of Nuclear Medicine (EANM) guidelines.
Patients were classified as well-responders (≤33% residual viable tumor) or poor-responders (>33% residual viable tumor) based on histology.

Main Results

In PT analysis, post-treatment metabolic parameters (except MTV) were lower in well-responders. Percentage changes in MTV (%ΔMTV) and TLG (%ΔTLG) were higher in poor-responders.
%ΔMTV41 demonstrated optimal performance in predicting well-responders (AUC=0.875) and correlated with recurrence-free survival.
In LN analysis, pre-treatment SULmax and SULpeak were lower in poor-responders. Post-treatment MTV50 and all percentage changes were higher in poor-responders.
%ΔTLG50 showed excellent predictive performance for well-responders (AUC=1.000).
No significant correlation was found between metabolic response evaluations for PTs and LNs.

Conclusions

18F-FDG PET/CT metabolic parameters, particularly %ΔMTV and %ΔTLG, can effectively predict response to neoadjuvant PD-L1 blockade in LA-ESCC.
These findings suggest potential for personalized immunotherapy and utility as a stratification tool in future clinical trials.

Keywords:

Locally advanced esophageal squamous cell carcinoma PD-L1 blockade monotherapy Pathological response [18F]FDG PET/CT