The Role of quantitative imaging biomarkers in an early FDG-PET/CT for detection of immune-related adverse events in melanoma patients: a prospective study

Authors

  • Nežka Hribernik MD
  • Katja Strašek Master of Physics
  • Daniel T Huff Master of Physics, PhD
  • Andrej Studen University Bachelor of Science in Physics, PhD
  • Katarina Zevnik MD
  • Katja Škalič graduate radiological engineer
  • Robert Jeraj Professor
  • Martina Reberšek Institute of Oncology Ljubljana

Abstract

Purpose To evaluate the role of the novel quantitative imaging biomarker (QIB) SUVX% of 18F-FDG uptake extracted from early 18F-FDG -PET/CT scan at 4 weeks for the detection of immune-related adverse events (rAE) in a cohort of patients with metastatic melanoma (mM) patients receiving immune-checkpoint inhibitors (ICI).

Methods In this prospective non-interventional, one-centre clinical study, patients with mM, receiving ICI treatment, were regularly followed by 18F-FDG PET/CT. Patients were scanned at baseline, early point at week four (W4), week sixteen (W16) and week thirty-two (W32) after ICI initiation. A convolutional neural network (CNN) was used to segment three organs: lung, bowel, thyroid. QIB of irAE - SUVX% - was analyzed within the target organs and correlated with the clinical irAE status. Area under the receiver-operating characteristic curve (AUROC) was used to quantify irAE detection performance.

Results A total of 242 18F-FDG PET/CT images of 71 mM patients were prospectively collected and analysed. The early W4 scan showed improved detection only for the thyroid gland compared to W32 scan (p=0.047). The AUROC for detection of irAE in the three target organs was highest when SUVX% was extracted from W16 scan and was 0.76 for lung, 0.53 for bowel and 0.81 for thyroid.  SUVX% extracted from W4 scan did not improve detection of irAE compared to W16 scan (lung: p= 0.54, bowel: p=0.75, thyroid: p=0.3, DeLong test), as well as compared to W32 scan in lungs (p=0.32) and bowel (p=0.3).

Conclusions Early time point 18F-FDG PET/CT at W4 did not lead to statistically significant earlier detection of irAE.  However, organ18F-FDG uptake as quantified by SUVX% proved to be a consistent QIB of irAE. To better assess the role of 18F-FDG PET/CT in irAE detection, the time evolution of 18F-FDG PET/CT quantifiable inflammation would be of essence, only achievable in multi centric studies.

Author Biographies

Nežka Hribernik, MD

Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia

Katja Strašek, Master of Physics

Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia

Daniel T Huff, Master of Physics, PhD

University of Wisconsin Carbone Cancer Centre, Madison, WI, USA

Andrej Studen, University Bachelor of Science in Physics, PhD

Experimental Particle Physics Department, Jožef Stefan Institute, Ljubljana, Slovenia

Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia

Katarina Zevnik, MD

Department of Nuclear Medicine, Institute of Oncology Ljubljana, Ljubljana, Slovenia

Katja Škalič, graduate radiological engineer

Department of Nuclear Medicine, Institute of Oncology Ljubljana, Ljubljana, Slovenia

Robert Jeraj, Professor

Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia

University of Wisconsin Carbone Cancer Centre, Madison, WI, USA

Department of Medical Physics, University of Wisconsin-Madison, Madison, WI

Experimental Particle Physics Department, Jožef Stefan Institute, Ljubljana, Slovenia

Martina Reberšek, Institute of Oncology Ljubljana

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Published

2024-09-09

How to Cite

Hribernik, N., Strašek, K., Huff, D. T., Studen, A., Zevnik, K., Škalič, K., … Reberšek, M. (2024). The Role of quantitative imaging biomarkers in an early FDG-PET/CT for detection of immune-related adverse events in melanoma patients: a prospective study. Radiology and Oncology, 58(3), 335–347. Retrieved from https://radioloncol.com/index.php/ro/article/view/4413

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Clinical oncology