18F-FDG PET and CT Scans Detect New Imaging Patterns of Response and Progression in Patients with Hodgkin Lymphoma Treated by Anti-Programmed Death 1 Immune Checkpoint Inhibitor
18F-FDG PET and CT Scans Detect New Imaging Patterns of Response and Progression in Patients with Hodgkin Lymphoma Treated by Anti-Programmed Death 1 Immune Checkpoint Inhibitor
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DOI：
10.2967/jnumed.117.193011
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发表时间：
2018-01-01
影响因子：
9.3
通讯作者：
Michot, Jean-Marie
中科院分区：
文献类型：
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作者：
Dercle, Laurent;Seban, Romain-David;Michot, Jean-Marie
霍奇金淋巴瘤（HL）患者的疗效评价标准旨在评估化疗和靶向分子药物。我们研究了3个月F-18-FDG PET/CT用于识别对抗程序性死亡1抗体（抗PD 1）免疫检查点阻断有反应的HL患者的准确性。我们还报告了新的免疫反应和进展模式的频率。方法：回顾性研究，我们招募了2013年至2015年在Gustave治疗中心接受抗PD 1（pembrolizumab或nivolumab）治疗的连续HL患者。每3个月进行一次F-18-FDG PET/CT和增强CT扫描。我们根据国际协调项目Cheson 2014标准和淋巴瘤免疫调节治疗反应标准（LYRIC）（2016年修订标准）记录最佳总体缓解。在抗PD 1治疗期间任何时间达到客观缓解的患者被归类为缓解者。结果：16例复发或难治性经典HL患者纳入研究。中位年龄为39岁（年龄范围，19-69岁）。中位既往治疗线为6线（范围，3-13线）。平均随访22.6个月。16例患者中有9例（56%）达到了客观缓解。7个月时发生2例因疾病进展死亡。F-18-FDG PET/CT在3个月时检测到所有应答者，与单独CT相比，5例患者的最佳总体应答重新分类。在3个月时，在应答者中观察到肿瘤代谢和体积（SUV平均值，代谢肿瘤体积）的减少和健康脾脏代谢的增加（曲线下面积> 0.85，P < 0.04）。16例患者中有5例（31%）显示与抗PD 1相关的新影像学模式;我们观察到2例一过性进展，与根据LYRIC（2016）的不确定缓解一致（14个月时的IR 2b和18个月时的IR 3），3例患者出现与免疫相关不良事件相关的新病变。结论：三个月的F-18-FDG PET/CT扫描检测到HL患者对抗PD 1有反应。在31%的患者中遇到了新的模式，强调需要在更大的系列中进行进一步评估，并在每位患者的基础上进行成像和肿瘤学专家之间的密切合作。
The response evaluation criteria in patients with Hodgkin lymphoma (HL) were designed for the assessment of chemotherapy and targeted molecular agents. We investigated the accuracy of 3-mo F-18-FDG PET/CT for the identification of HL patients responding to immune-checkpoint blockade by anti-programmed death 1 antibodies (anti-PD1). We also reported the frequency of new immune patterns of response and progression. Methods: Retrospectively, we recruited consecutive HL patients treated by anti-PD1 (pembrolizumab or nivolumab) at Gustave Roussy from 2013 to 2015. F-18-FDG PET/CT and contrast-enhanced CT scans were acquired every 3 mo. We recorded the best overall response according to the International Harmonization Project Cheson 2014 criteria and LYmphoma Response to Immunomodulatory therapy Criteria (LYRIC) (2016 revised criteria). Patients achieving an objective response at any time during the anti-PD1 treatment were classified as responders. Results: Sixteen relapsed or refractory classic HL patients were included. The median age was 39 y (age range, 19-69 y). The median previous lines of therapy was 6 (range, 3-13). The mean follow-up was 22.6 mo. Nine of 16 patients (56%) achieved an objective response. Two deaths occurred due to progressive disease at 7 mo. F-18-FDG PET/CT detected all responders at 3 mo and reclassified best overall response in 5 patients compared with CT alone. A decrease in tumor metabolism and volume (SUVmean, metabolic tumor volume) and increase in healthy splenic metabolism at 3 mo were observed in responders (area under the curve > 0.85, P < 0.04). Five of 16 patients (31%) displayed new imaging patterns related to anti-PD1; we observed 2 transient progressions consistent with indeterminate response according to the LYRIC (2016) (IR2b at 14 mo and IR3 at 18 mo) and 3 patients with new lesions associated with immune-related adverse events. Conclusion: Three-month F-18-FDG PET/CT scans detected HL patients responding to anti-PD1. New patterns were encountered in 31% of patients, emphasizing the need for further evaluation in larger series and close collaboration between imaging and oncology specialists on a per-patient basis.