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

Hribernik, Nežka (author), Strašek, Katja (author), Huff, Daniel T. (author), Studen, Andrej (author), Zevnik, Katarina (author), Škalič, Katja (author), Jeraj, Robert (author), Reberšek, Martina (author)

Background. To evaluate the role of the novel quantitative imaging biomarker (QIB) SUV$_{X\%}$ of $^{18}$F-FDG uptake ex-tracted 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). Patients and methods. In this prospective non-interventional, one-centre clinical study, patients with mM, receiv-ing ICI treatment, were regularly followed by $^{18}$F-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 - SUV$_{X\%}$ - 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 $^{18}$F-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 SUV$_{X\%}$ was extracted from W16 scan and was 0.76 for lung, 0.53 for bowel and 0.81 for thyroid. SUV$_{X\%}$ 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 $^{18}$F-FDG PET/CT at W4 did not lead to statistically significant earlier detection ofirAE. However, organ18F-FDG uptake as quantified by SUV$_{X\%}$ proved to be a consistent QIB of irAE. To better assess the role of $^{18}$F-FDG PET/CT in irAE detection, the time evolution of $^{18}$F-FDG PET/CT quantifiable inflammation would be of essence, only achievable in multi centric studies.

• Language: English
• Keywords: medical imaging, FDG-PET/C, biomarkers, immunotherapy, immune checkpoint inhibitors
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: FMF - Faculty of Mathematics and Physics
• Publication status: Published
• Publication version: Version of Record
• Year: 2024
• Number of pages: Str. 335-347
• Numbering: Vol. 58, no. 3
• PID: 20.500.12556/RUL-162189
• UDC: 616-073
• ISSN on article: 1318-2099
• DOI: 10.2478/raon-2024-0045
• COBISS.SI-ID: 208199939
• Publication date in RUL: 19.09.2024

Record is a part of a journal

• Title: Radiology and oncology
• Shortened title: Radiol. oncol.
• Publisher: Slovenian Medical Society - Section of Radiology, Croatian Medical Association - Croatian Society of Radiology
• ISSN: 1318-2099
• COBISS.SI-ID: 32649472

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: medicinsko slikanje, FDG-PET/C, biomarkerji, imunoterpija, zaviralci imunskih kontrolnih točk

Projects

• Funder: ARIS - Slovenian Research and Innovation Agency
• Project number: P3-0321-2020
• Name: Napovedni dejavniki poteka bolezni in odgovora na zdravljenje pri različnih vrst raka

• Funder: ARIS - Slovenian Research and Innovation Agency
• Project number: P1-0389-2022
• Name: Medicinska fizika