Baseline metabolic tumor volume has a strong predictive and prognostic value in non-small cell lung cancer patients treated with immunotherapy

Purpose: Reliable predictive and prognostic markers are still lacking for patients treated with immunotherapy for non-small cell lung cancer (NSCLC). The purpose of this study was to investigate the prognostic and predictive values of different baseline metabolic parameters, including whole-body metabolic tumor volume (wMTV), from ¹⁸F-FDG PET/CT scans in patients with NSCLC treated with immunotherapy.

Methods: Maximum and peak standardized uptake values, wMTV and total lesion glycolysis (wTLG) as well as clinical and biological parameters, were recorded in 75 prospectively included patients with NSCLC treated with immunotherapy. Associations between these parameters and overall survival (OS) were evaluated as well as their accuracy to predict early treatment discontinuation (ETD).

Results: A high wMTV and a high wTLG were significantly associated with a lower OS (p < 0.001). The median OS in patients with wMTV above the median (36.5 cm³) was 10.5 months (95% CI: 6.2 - upper limit: unreached) while the median OS in patients with wMTV below the median was not reached (image1). Patients with no prior chemotherapy had a poorer OS than patients which had received prior systemic treatment (p=0.04). wMTV and wTLG could reliably predict ETD (ROC curve AUC = 0.76, 95% CI: 0.65-0.87 and 0.72, 95% CI: 0.62-0.84 respectively). Conclusion: wMTV is a strong prognostic and predictive factor in NSCLC patients treated with immunotherapy, and can be easily determined from routine ¹⁸F-FDG PET/CT scans. wMTV, could help to personalize immunotherapy and used in future clinical studies.

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