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Research ArticleOncology

Treatment Monitoring of Immunotherapy and Targeted Therapy Using 18F-FET PET in Patients with Melanoma and Lung Cancer Brain Metastases: Initial Experiences

Norbert Galldiks, Diana S.Y. Abdulla, Matthias Scheffler, Fabian Wolpert, Jan-Michael Werner, Martin Hüllner, Gabriele Stoffels, Viola Schweinsberg, Max Schlaak, Nicole Kreuzberg, Jennifer Landsberg, Philipp Lohmann, Garry Ceccon, Christian Baues, Maike Trommer, Eren Celik, Maximilian I. Ruge, Martin Kocher, Simone Marnitz, Gereon R. Fink, Jörg-Christian Tonn, Michael Weller, Karl-Josef Langen, Jürgen Wolf and Cornelia Mauch
Journal of Nuclear Medicine April 2021, 62 (4) 464-470; DOI: https://doi.org/10.2967/jnumed.120.248278
Norbert Galldiks
1Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
3Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
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Diana S.Y. Abdulla
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
4Lung Cancer Group, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Matthias Scheffler
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
4Lung Cancer Group, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Fabian Wolpert
5Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
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Jan-Michael Werner
1Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Martin Hüllner
6Department of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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Gabriele Stoffels
3Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
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Viola Schweinsberg
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
7Department of Dermatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Max Schlaak
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
7Department of Dermatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Nicole Kreuzberg
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
7Department of Dermatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Jennifer Landsberg
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
8Department of Dermatology, University Hospital Bonn, Bonn, Germany
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Philipp Lohmann
3Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
9Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Garry Ceccon
1Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Christian Baues
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
10Department of Radiation Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Maike Trommer
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
10Department of Radiation Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Eren Celik
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
9Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Maximilian I. Ruge
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
9Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Martin Kocher
3Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
9Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Simone Marnitz
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
10Department of Radiation Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Gereon R. Fink
1Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
3Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
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Jörg-Christian Tonn
11Department of Neurosurgery, University Hospital LMU Munich, Munich, Germany; and
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Michael Weller
5Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
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Karl-Josef Langen
3Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
12Department of Nuclear Medicine, RWTH University Hospital Aachen, Aachen, Germany
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Jürgen Wolf
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
4Lung Cancer Group, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Cornelia Mauch
2Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
7Department of Dermatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Abstract

We investigated the value of O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) PET for treatment monitoring of immune checkpoint inhibition (ICI) or targeted therapy (TT) alone or in combination with radiotherapy in patients with brain metastasis (BM) since contrast-enhanced MRI often remains inconclusive. Methods: We retrospectively identified 40 patients with 107 BMs secondary to melanoma (n = 29 with 75 BMs) or non–small cell lung cancer (n = 11 with 32 BMs) treated with ICI or TT who had 18F-FET PET (n = 60 scans) for treatment monitoring from 2015 to 2019. Most patients (n = 37; 92.5%) had radiotherapy during the course of the disease. In 27 patients, 18F-FET PET was used to differentiate treatment-related changes from BM relapse after ICI or TT. In 13 patients, 18F-FET PET was performed for response assessment to ICI or TT using baseline and follow-up scans (median time between scans, 4.2 mo). In all lesions, static and dynamic 18F-FET PET parameters were obtained (i.e., mean tumor-to-brain ratios [TBR], time-to-peak values). Diagnostic accuracies of PET parameters were evaluated by receiver-operating-characteristic analyses using the clinical follow-up or neuropathologic findings as a reference. Results: A TBR threshold of 1.95 differentiated BM relapse from treatment-related changes with an accuracy of 85% (P = 0.003). Metabolic responders to ICI or TT on 18F-FET PET had a significantly longer stable follow-up (threshold of TBR reduction relative to baseline, ≥10%; accuracy, 82%; P = 0.004). Furthermore, at follow-up, time to peak in metabolic responders increased significantly (P = 0.019). Conclusion: 18F-FET PET may add valuable information for treatment monitoring in BM patients treated with ICI or TT.

  • checkpoint inhibitors
  • pseudoprogression
  • response assessment
  • treatment-related changes
  • radionecrosis

Footnotes

  • Published online Sep. 4, 2020.

  • © 2021 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 62 (4)
Journal of Nuclear Medicine
Vol. 62, Issue 4
April 1, 2021
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Treatment Monitoring of Immunotherapy and Targeted Therapy Using 18F-FET PET in Patients with Melanoma and Lung Cancer Brain Metastases: Initial Experiences
Norbert Galldiks, Diana S.Y. Abdulla, Matthias Scheffler, Fabian Wolpert, Jan-Michael Werner, Martin Hüllner, Gabriele Stoffels, Viola Schweinsberg, Max Schlaak, Nicole Kreuzberg, Jennifer Landsberg, Philipp Lohmann, Garry Ceccon, Christian Baues, Maike Trommer, Eren Celik, Maximilian I. Ruge, Martin Kocher, Simone Marnitz, Gereon R. Fink, Jörg-Christian Tonn, Michael Weller, Karl-Josef Langen, Jürgen Wolf, Cornelia Mauch
Journal of Nuclear Medicine Apr 2021, 62 (4) 464-470; DOI: 10.2967/jnumed.120.248278

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Treatment Monitoring of Immunotherapy and Targeted Therapy Using 18F-FET PET in Patients with Melanoma and Lung Cancer Brain Metastases: Initial Experiences
Norbert Galldiks, Diana S.Y. Abdulla, Matthias Scheffler, Fabian Wolpert, Jan-Michael Werner, Martin Hüllner, Gabriele Stoffels, Viola Schweinsberg, Max Schlaak, Nicole Kreuzberg, Jennifer Landsberg, Philipp Lohmann, Garry Ceccon, Christian Baues, Maike Trommer, Eren Celik, Maximilian I. Ruge, Martin Kocher, Simone Marnitz, Gereon R. Fink, Jörg-Christian Tonn, Michael Weller, Karl-Josef Langen, Jürgen Wolf, Cornelia Mauch
Journal of Nuclear Medicine Apr 2021, 62 (4) 464-470; DOI: 10.2967/jnumed.120.248278
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Keywords

  • checkpoint inhibitors
  • pseudoprogression
  • response assessment
  • treatment-related changes
  • radionecrosis
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