Prognostic Value of PET-Based Metabolic Markers in Nivolumab-Treated NSCLC

Abstract

Objective: This study aimed to assess the prognostic significance of 18F-FDG PET/CT metabolic parameters in patients with non-small cell lung cancer (NSCLC) receiving nivolumab as second-line therapy. The study also explored associations between these parameters, treatment response, and survival outcomes. Methods: A retrospective analysis was performed on 32 stage IV NSCLC patients who received at least four doses of nivolumab and underwent both baseline and follow-up PET/CT scans. Metabolic parameters, including SUVmax, SUVmean, total metabolic tumor volume (tMTV), and total lesion glycolysis (tTLG), were measured. Treatment response was classified according to EORTC criteria. Kaplan–Meier analysis and log-rank tests were applied for survival comparisons, and non-parametric methods evaluate associations. Results: Patients with partial metabolic response demonstrated significantly longer post-nivolumab survival. Post-treatment SUVmax, SUVmean, and tTLG differed significantly among response categories. Pretreatment tMTV and tTLG, and post-treatment SUVmax, SUVmean, and tTLG, were significantly associated with mortality (p < 0.05). Lower baseline tMTV and tTLG, and lower post-treatment SUVmax, SUVmean, tMTV, and tTLG were significantly associated with longer overall and post-nivolumab survival (p < 0.05). Post-treatment SUVmax and SUVmean were strong predictors of mortality. Conclusion: PET/CT-derived metabolic parameters, especially post-treatment SUVmax and SUVmean, offer valuable prognostic insights and may support personalized immunotherapy strategies in advanced NSCLC.

Keywords

• Non-small cell lung cancer
• Nivolumab
• 18F-FDG PET/CT
• Metabolic parameters
• Survival

References

1. 1. Ayati, N., Lee, S. T., Zakavi, S. R., Cheng, M., Lau, W. F. E., Parakh, S., Pathmaraj, K., & Scott, A. M. (2021). Response Evaluation and Survival Prediction After PD-1 Immunotherapy in Patients with Non-Small Cell Lung Cancer: Comparison of Assessment Methods. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 62(7), 926–933. https://doi.org/10.2967/jnumed.120.254508
2. 2. Brahmer, J., Reckamp, K. L., Baas, P., Crinò, L., Eberhardt, W. E., Poddubskaya, E., Antonia, S., Pluzanski, A., Vokes, E. E., Holgado, E., Waterhouse, D., Ready, N., Gainor, J., Arén Frontera, O., Havel, L., Steins, M., Garassino, M. C., Aerts, J. G., Domine, M., Paz-Ares, L., … Spigel, D. R. (2015). Nivolumab versus Docetaxel in Advanced Squamous-Cell Non-Small-Cell Lung Cancer. The New England journal of medicine, 373(2), 123–135. https://doi.org/10.1056/NEJMoa1504627
3. 3. Borghaei, H., Paz-Ares, L., Horn, L., Spigel, D. R., Steins, M., Ready, N. E., Chow, L. Q., Vokes, E. E., Felip, E., Holgado, E., Barlesi, F., Kohlhäufl, M., Arrieta, O., Burgio, M. A., Fayette, J., Lena, H., Poddubskaya, E., Gerber, D. E., Gettinger, S. N., Rudin, C. M., … Brahmer, J. R. (2015). Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer. The New England journal of medicine, 373(17), 1627–1639. https://doi.org/10.1056/NEJMoa1507643
4. 4. Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834
5. 5. Hashimoto, K., Kaira, K., Yamaguchi, O., Mouri, A., Shiono, A., Miura, Y., Murayama, Y., Kobayashi, K., Kagamu, H., & Kuji, I. (2020). Potential of FDG-PET as Prognostic Significance after anti-PD-1 Antibody against Patients with Previously Treated Non-Small Cell Lung Cancer. Journal of clinical medicine, 9(3), 725. https://doi.org/10.3390/jcm9030725
6. 6. Horn, L., Spigel, D. R., Vokes, E. E., Holgado, E., Ready, N., Steins, M., Poddubskaya, E., Borghaei, H., Felip, E., Paz-Ares, L., Pluzanski, A., Reckamp, K. L., Burgio, M. A., Kohlhäeufl, M., Waterhouse, D., Barlesi, F., Antonia, S., Arrieta, O., Fayette, J., Crinò, L., … Eberhardt, W. E. E. (2017). Nivolumab Versus Docetaxel in Previously Treated Patients With Advanced Non-Small-Cell Lung Cancer: Two-Year Outcomes From Two Randomized, Open-Label, Phase III Trials (CheckMate 017 and CheckMate 057). Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 35(35), 3924–3933. https://doi.org/10.1200/JCO.2017.74.3062