Comparing [18F]FDG PET/CT response criteria in melanoma and lung cancer patients treated with immunotherapy: a systematic review

Purpose To compare the predictive value of new immunotherapy-specific fluorine-18-labeled glucose Positron Emission Tomography/Computed Tomography ([ 18 F]FDG PET/CT) response criteria to conventional PET/CT criteria for overall survival (OS) in melanoma and lung cancer patients treated with immunot...

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Published in:Clinical and translational imaging : reviews in nuclear medicine and molecular imaging 2022-12, Vol.10 (6), p.643-661
Main Authors: Saadani, Hanna, Aalbersberg, Else A., Schats, Winnie, Hoekstra, Otto S., Stokkel, Marcel P. M., de Vet, Henrica C. W.
Format: Article
Language:English
Subjects:
Computed tomography
Confidence intervals
Criteria
Diagnostic Radiology
Fluorine
Fluorine isotopes
Imaging
Immunotherapy
Interventional Radiology
Lung cancer
Medical and Radiation Physics
Medicine
Medicine & Public Health
Melanoma
Nuclear Medicine
Oncology
Positron emission
Quality assessment
Radiology
Radiotherapy
Systematic Review
Tomography
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Summary:Purpose To compare the predictive value of new immunotherapy-specific fluorine-18-labeled glucose Positron Emission Tomography/Computed Tomography ([ 18 F]FDG PET/CT) response criteria to conventional PET/CT criteria for overall survival (OS) in melanoma and lung cancer patients treated with immunotherapy. Methods MEDLINE (Ovid), Embase, Scopus, Web of Science and the Cochrane Library databases were searched until June 4, 2021, in line with the PRISMA statement. Two reviewers independently screened resulting records. Quality assessment was performed according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and/or Quality in Prognostic Studies (QUIPS) criteria. PET/CT response assessment was divided in immunotherapy PET/CT response criteria, conventional PET/CT response criteria, and individual Δ[ 18 F]FDG/PET CT metrics. The main outcome measure extracted was the univariate hazard ratio (HR) for OS. Results Fifteen studies ( n  = 565) were included, with ten studies (225 NSCLC, 178 melanoma cases) reporting on PET/CT response criteria and five studies (126 NSCLC, 36 melanoma cases) on individual Δ[ 18 F]FDG PET/CT metrics. Until 2016, conventional criteria: EORTC and PERCIST1.0 were applied; since then, several new, modified criteria emerged: imPERCIST, PERCIMT, PECRIT and iPERCIST. For both NSCLC and melanoma, univariate HRs did not show substantial differences between immunotherapy and conventional PET/CT response criteria, with overlapping confidence intervals. No individual Δ[ 18 F]FDG PET/CT metric can yet be recommended. ΔTMTV in melanoma and ΔSUVmax in NSCLC showed the highest univariate HRs. Conclusion There is insufficient evidence to decide whether the predictive value of immunotherapy PET/CT criteria is superior to conventional ones for OS, in melanoma and lung cancer treated with immunotherapy. A different research strategy is needed to reach the answer: PET/CT research should focus on directly comparing (modifications of) immunotherapy and conventional PET/CT criteria within a homogenous population with standardized PET timing, immunotherapy categories and OS definition. A consortium-based comprehensive database with individual patient data could be the solution.
ISSN:2281-7565
2281-5872
2281-7565
DOI:10.1007/s40336-022-00522-8