RT Journal Article
SR Electronic
T1 PD-L1 PET/CT imaging with radiolabeled durvalumab in patients with advanced stage non-small cell lung cancer.
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP jnumed.121.262473
DO 10.2967/jnumed.121.262473
A1 Jasper Smit
A1 Frank Johannes Borm
A1 Anna-Larissa N Niemeijer
A1 Marc C Huisman
A1 Otto S Hoekstra
A1 Ronald Boellaard
A1 Daniela Elena Oprea-Lager
A1 Danielle J Vugts
A1 Guus AMS van Dongen
A1 Berlinda J de Wit- van der Veen
A1 Erik Thunnissen
A1 Egbert F Smit
A1 Adrianus J de Langen
YR 2021
UL http://jnm.snmjournals.org/content/early/2021/08/12/jnumed.121.262473.abstract
AB Background: Better biomarkers are needed to predict treatment outcome in NSCLC patients treated with anti PD-(L)1 checkpoint inhibitors. PD-L1 immunohistochemistry has limited predictive value, possibly due to tumor heterogeneity of PD-L1 expression. Noninvasive PD-L1 imaging using 89Zr-durvalumab might provide a better reflection of tumor PD-L1 expression and can therefore support treatment decision making. Patients and Methods: NSCLC patients eligible for second line immunotherapy treatment were enrolled. Patients received two injections of 89Zr-durvalumab; one without a preceding dose of unlabeled durvalumab (‘tracer dose only’) and one with a preceding dose of 750 mg durvalumab, directly prior to tracer injection. Up to four PET/CT scans were obtained after tracer injection. Post-imaging acquisition, patients were treated with 750mg durvalumab every two weeks. Tracer biodistribution and tumor uptake were visually assessed and quantified as standardized uptake value (SUV) and both imaging acquisitions were compared. Tumor tracer uptake was correlated with PD-L1 expression and clinical outcome, defined as treatment response to durvalumab treatment. Results: Thirteen patients were included and ten completed all scheduled PET scans. No tracer related adverse events were observed and all patients started durvalumab treatment. Biodistribution analysis showed 89Zr-durvalumab accumulation in the blood pool, liver and spleen. Serial imaging showed that image acquisition 120 hours post injection delivered the best tumor to blood pool ratio. Most tumor lesions were visualized with the tracer-dose only versus the co-injection imaging acquisition (25% vs 13.5% of all lesions). Uptake heterogeneity was observed within (range SUVpeak 0.2 to 15.1) and between patients. Tumor uptake was higher in patients with treatment response or stable disease, compared to patients with disease progression according to RECIST 1.1. However, this difference was not statistically significant (median SUVpeak 4.9 vs 2.4, P = 0.06). SUVpeak correlated better with the combined tumor and immune cell PD-L1 score than with PD-L1 expression on tumor cells, although both were not statistically significant (P = 0.06 and P = 0.93, respectively). Conclusion: 89Zr-durvalumab was safe without any tracer related adverse events and more tumor lesions were visualized using the tracer dose only imaging acquisition. 89Zr-durvalumab tumor uptake was higher in patients with response to durvalumab treatment, but did not correlate with tumor PD-L1 IHC.