Abstract | PURPOSE: We assessed the predictive potential of positron emission tomography (PET)/CT-based radiomics, lesion volume, and routine blood markers for early differentiation of pseudoprogression from true progression at 3 months. EXPERIMENTAL DESIGN: 112 patients with metastatic melanoma treated with immune checkpoint inhibition were included in our study. Median follow-up duration was 22 months. 716 metastases were segmented individually on CT and 2[18F]fluoro- 2-deoxy-D-glucose (FDG)-PET imaging at three timepoints: baseline (TP0), 3 months (TP1), and 6 months (TP2). Response was defined on a lesion-individual level (RECIST 1.1) and retrospectively correlated with FDG-PET/CT radiomic features and the blood markers LDH/S100. Seven multivariate prediction model classes were generated. RESULTS: Two-year (median) overall survival, progression-free survival, and immune progression-free survival were 69% (not reached), 24% (6 months), and 42% (16 months), respectively. At 3 months, 106 (16%) lesions had progressed, of which 30 (5%) were identified as pseudoprogression at 6 months. Patients with pseudoprogressive lesions and without true progressive lesions had a similar outcome to responding patients and a significantly better 2-year overall survival of 100% (30 months), compared with 15% (10 months) in patients with true progressions/without pseudoprogression (P = 0.002). Patients with mixed progressive/pseudoprogressive lesions were in between at 53% (25 months). The blood prediction model (LDH+S100) achieved an AUC = 0.71. Higher LDH/S100 values indicated a low chance of pseudoprogression. Volume-based models: AUC = 0.72 (TP1) and AUC = 0.80 (delta-volume between TP0/TP1). Radiomics models (including/excluding volume-related features): AUC = 0.79/0.78. Combined blood/volume model: AUC = 0.79. Combined blood/radiomics model (including volume-related features): AUC = 0.78. The combined blood/radiomics model (excluding volume-related features) performed best: AUC = 0.82. CONCLUSIONS: Noninvasive PET/CT-based radiomics, especially in combination with blood parameters, are promising biomarkers for early differentiation of pseudoprogression, potentially avoiding added toxicity or delayed treatment switch.
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Authors | Lucas Basler, Hubert S Gabryś, Sabrina A Hogan, Matea Pavic, Marta Bogowicz, Diem Vuong, Stephanie Tanadini-Lang, Robert Förster, Ken Kudura, Martin W Huellner, Reinhard Dummer, Matthias Guckenberger, Mitchell P Levesque |
Journal | Clinical cancer research : an official journal of the American Association for Cancer Research
(Clin Cancer Res)
Vol. 26
Issue 16
Pg. 4414-4425
(08 15 2020)
ISSN: 1557-3265 [Electronic] United States |
PMID | 32253232
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | ©2020 American Association for Cancer Research. |
Chemical References |
- Immune Checkpoint Inhibitors
- Radiopharmaceuticals
- Fluorodeoxyglucose F18
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Topics |
- Adult
- Disease Progression
- Female
- Fluorodeoxyglucose F18
(administration & dosage)
- Humans
- Immune Checkpoint Inhibitors
(pharmacology)
- Male
- Melanoma
(blood, diagnostic imaging, drug therapy)
- Middle Aged
- Neoplasms, Second Primary
- Positron Emission Tomography Computed Tomography
- Positron-Emission Tomography
- Progression-Free Survival
- Radiopharmaceuticals
(administration & dosage)
- Tumor Burden
(genetics)
- Young Adult
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