Predicting treatment outcomes using 18F-FDG PET biomarkers in patients with non-small-cell lung cancer receiving chemoimmunotherapy

Chang Gon Kim; Sang Hyun Hwang; Kyung Hwan Kim; Hong In Yoon; Hyo Sup Shim; Ji Hyun Lee; Yejeong Han; Beung Chul Ahn; Min Hee Hong; Hye Ryun Kim; Byoung Chul Cho; Arthur Cho; Sun Min Lim

doi:10.1177/17588359211068732

Predicting treatment outcomes using ¹⁸F-FDG PET biomarkers in patients with non-small-cell lung cancer receiving chemoimmunotherapy

Chang Gon Kim, Sang Hyun Hwang, Kyung Hwan Kim, Hong In Yoon, Hyo Sup Shim, Ji Hyun Lee, Yejeong Han, Beung Chul Ahn, Min Hee Hong, Hye Ryun Kim, Byoung Chul Cho, Arthur Cho, Sun Min Lim

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background: Predictive markers for treatment response and survival outcome have not been identified in patients with advanced non-small-cell lung cancer (NSCLC) receiving chemoimmunotherapy. We aimed to evaluate whether imaging biomarkers of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) and routinely assessed clinico-laboratory values were associated with clinical outcomes in patients with advanced NSCLC receiving pembrolizumab plus platinum-doublet chemotherapy as a first-line treatment. Methods: We retrospectively enrolled 52 patients with advanced NSCLC who underwent baseline ¹⁸F-FDG PET/CT before treatment initiation. PET/CT parameters and clinico-laboratory variables, constituting the prognostic immunotherapy scoring system, were collected. Optimal cut-off values for PET/CT parameters were determined using the maximized log-rank test for progression-free survival (PFS). A multivariate prediction model was developed based on Cox models for PFS, and a scoring system was established based on hazard ratios of the predictive factors. Results: During the median follow-up period of 16.7 months (95% confidence interval: 15.7–17.7 months), 43 (82.7%) and 31 (59.6%) patients experienced disease progression and death, respectively. Objective response was observed in 23 (44.2%) patients. In the multivariate analysis, maximum standardized uptake value, metabolic tumour volume_2.5, total lesion glycolysis_2.5, and bone marrow-to-liver uptake ratio from the PET/CT variables and neutrophil-to-lymphocyte ratio (NLR) from the clinico-laboratory variables were independently associated with PFS. The scoring system based on these independent predictive variables significantly predicted the treatment response, PFS, and overall survival. Conclusion: PET/CT variables and NLR were useful biomarkers for predicting outcomes of patients with NSCLC receiving pembrolizumab and chemotherapy as a first-line treatment, suggesting their potential as effective markers for combined PD-1 blockade and chemotherapy.

Original language	English
Journal	Therapeutic Advances in Medical Oncology
Volume	14
DOIs	https://doi.org/10.1177/17588359211068732
Publication status	Published - 2022 Jan

Bibliographical note

Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2016R1D1A1B01014677 to A.C. and NRF-2019R1A2C4069993 to S.M.L.) and Young Medical Scientist Research Grant Program of the Daewoong Foundation (DY20206 P to C.G.K.).

Publisher Copyright:
© The Author(s), 2022.

All Science Journal Classification (ASJC) codes

Oncology

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1177/17588359211068732

Cite this

Kim, C. G., Hwang, S. H., Kim, K. H., Yoon, H. I., Shim, H. S., Lee, J. H., Han, Y., Ahn, B. C., Hong, M. H., Kim, H. R., Cho, B. C., Cho, A., & Lim, S. M. (2022). Predicting treatment outcomes using ¹⁸F-FDG PET biomarkers in patients with non-small-cell lung cancer receiving chemoimmunotherapy. Therapeutic Advances in Medical Oncology, 14. https://doi.org/10.1177/17588359211068732

@article{9e083d9fdec749e39dc41dead280bf46,

title = "Predicting treatment outcomes using 18F-FDG PET biomarkers in patients with non-small-cell lung cancer receiving chemoimmunotherapy",

abstract = "Background: Predictive markers for treatment response and survival outcome have not been identified in patients with advanced non-small-cell lung cancer (NSCLC) receiving chemoimmunotherapy. We aimed to evaluate whether imaging biomarkers of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and routinely assessed clinico-laboratory values were associated with clinical outcomes in patients with advanced NSCLC receiving pembrolizumab plus platinum-doublet chemotherapy as a first-line treatment. Methods: We retrospectively enrolled 52 patients with advanced NSCLC who underwent baseline 18F-FDG PET/CT before treatment initiation. PET/CT parameters and clinico-laboratory variables, constituting the prognostic immunotherapy scoring system, were collected. Optimal cut-off values for PET/CT parameters were determined using the maximized log-rank test for progression-free survival (PFS). A multivariate prediction model was developed based on Cox models for PFS, and a scoring system was established based on hazard ratios of the predictive factors. Results: During the median follow-up period of 16.7 months (95% confidence interval: 15.7–17.7 months), 43 (82.7%) and 31 (59.6%) patients experienced disease progression and death, respectively. Objective response was observed in 23 (44.2%) patients. In the multivariate analysis, maximum standardized uptake value, metabolic tumour volume2.5, total lesion glycolysis2.5, and bone marrow-to-liver uptake ratio from the PET/CT variables and neutrophil-to-lymphocyte ratio (NLR) from the clinico-laboratory variables were independently associated with PFS. The scoring system based on these independent predictive variables significantly predicted the treatment response, PFS, and overall survival. Conclusion: PET/CT variables and NLR were useful biomarkers for predicting outcomes of patients with NSCLC receiving pembrolizumab and chemotherapy as a first-line treatment, suggesting their potential as effective markers for combined PD-1 blockade and chemotherapy.",

author = "Kim, {Chang Gon} and Hwang, {Sang Hyun} and Kim, {Kyung Hwan} and Yoon, {Hong In} and Shim, {Hyo Sup} and Lee, {Ji Hyun} and Yejeong Han and Ahn, {Beung Chul} and Hong, {Min Hee} and Kim, {Hye Ryun} and Cho, {Byoung Chul} and Arthur Cho and Lim, {Sun Min}",

note = "Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2016R1D1A1B01014677 to A.C. and NRF-2019R1A2C4069993 to S.M.L.) and Young Medical Scientist Research Grant Program of the Daewoong Foundation (DY20206 P to C.G.K.). Publisher Copyright: {\textcopyright} The Author(s), 2022.",

year = "2022",

month = jan,

doi = "10.1177/17588359211068732",

language = "English",

volume = "14",

journal = "Therapeutic Advances in Medical Oncology",

issn = "1758-8340",

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TY - JOUR

T1 - Predicting treatment outcomes using 18F-FDG PET biomarkers in patients with non-small-cell lung cancer receiving chemoimmunotherapy

AU - Kim, Chang Gon

AU - Hwang, Sang Hyun

AU - Kim, Kyung Hwan

AU - Yoon, Hong In

AU - Shim, Hyo Sup

AU - Lee, Ji Hyun

AU - Han, Yejeong

AU - Ahn, Beung Chul

AU - Hong, Min Hee

AU - Kim, Hye Ryun

AU - Cho, Byoung Chul

AU - Cho, Arthur

AU - Lim, Sun Min

N1 - Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2016R1D1A1B01014677 to A.C. and NRF-2019R1A2C4069993 to S.M.L.) and Young Medical Scientist Research Grant Program of the Daewoong Foundation (DY20206 P to C.G.K.). Publisher Copyright: © The Author(s), 2022.

PY - 2022/1

Y1 - 2022/1

N2 - Background: Predictive markers for treatment response and survival outcome have not been identified in patients with advanced non-small-cell lung cancer (NSCLC) receiving chemoimmunotherapy. We aimed to evaluate whether imaging biomarkers of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and routinely assessed clinico-laboratory values were associated with clinical outcomes in patients with advanced NSCLC receiving pembrolizumab plus platinum-doublet chemotherapy as a first-line treatment. Methods: We retrospectively enrolled 52 patients with advanced NSCLC who underwent baseline 18F-FDG PET/CT before treatment initiation. PET/CT parameters and clinico-laboratory variables, constituting the prognostic immunotherapy scoring system, were collected. Optimal cut-off values for PET/CT parameters were determined using the maximized log-rank test for progression-free survival (PFS). A multivariate prediction model was developed based on Cox models for PFS, and a scoring system was established based on hazard ratios of the predictive factors. Results: During the median follow-up period of 16.7 months (95% confidence interval: 15.7–17.7 months), 43 (82.7%) and 31 (59.6%) patients experienced disease progression and death, respectively. Objective response was observed in 23 (44.2%) patients. In the multivariate analysis, maximum standardized uptake value, metabolic tumour volume2.5, total lesion glycolysis2.5, and bone marrow-to-liver uptake ratio from the PET/CT variables and neutrophil-to-lymphocyte ratio (NLR) from the clinico-laboratory variables were independently associated with PFS. The scoring system based on these independent predictive variables significantly predicted the treatment response, PFS, and overall survival. Conclusion: PET/CT variables and NLR were useful biomarkers for predicting outcomes of patients with NSCLC receiving pembrolizumab and chemotherapy as a first-line treatment, suggesting their potential as effective markers for combined PD-1 blockade and chemotherapy.

AB - Background: Predictive markers for treatment response and survival outcome have not been identified in patients with advanced non-small-cell lung cancer (NSCLC) receiving chemoimmunotherapy. We aimed to evaluate whether imaging biomarkers of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and routinely assessed clinico-laboratory values were associated with clinical outcomes in patients with advanced NSCLC receiving pembrolizumab plus platinum-doublet chemotherapy as a first-line treatment. Methods: We retrospectively enrolled 52 patients with advanced NSCLC who underwent baseline 18F-FDG PET/CT before treatment initiation. PET/CT parameters and clinico-laboratory variables, constituting the prognostic immunotherapy scoring system, were collected. Optimal cut-off values for PET/CT parameters were determined using the maximized log-rank test for progression-free survival (PFS). A multivariate prediction model was developed based on Cox models for PFS, and a scoring system was established based on hazard ratios of the predictive factors. Results: During the median follow-up period of 16.7 months (95% confidence interval: 15.7–17.7 months), 43 (82.7%) and 31 (59.6%) patients experienced disease progression and death, respectively. Objective response was observed in 23 (44.2%) patients. In the multivariate analysis, maximum standardized uptake value, metabolic tumour volume2.5, total lesion glycolysis2.5, and bone marrow-to-liver uptake ratio from the PET/CT variables and neutrophil-to-lymphocyte ratio (NLR) from the clinico-laboratory variables were independently associated with PFS. The scoring system based on these independent predictive variables significantly predicted the treatment response, PFS, and overall survival. Conclusion: PET/CT variables and NLR were useful biomarkers for predicting outcomes of patients with NSCLC receiving pembrolizumab and chemotherapy as a first-line treatment, suggesting their potential as effective markers for combined PD-1 blockade and chemotherapy.

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