RT Journal Article
SR Electronic
T1 Study of <sup>89</sup>Zr-Pembrolizumab PET/CT 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 362
OP 367
DO 10.2967/jnumed.121.261926
VO 63
IS 3
A1 Niemeijer, Anna-Larissa N.
A1 Oprea-Lager, Daniela E.
A1 Huisman, Marc C.
A1 Hoekstra, Otto S.
A1 Boellaard, Ronald
A1 de Wit-van der Veen, Berlinda J.
A1 Bahce, Idris
A1 Vugts, Daniëlle J.
A1 van Dongen, Guus A.M.S.
A1 Thunnissen, Erik
A1 Smit, Egbert F.
A1 de Langen, Adrianus J.
YR 2022
UL http://jnm.snmjournals.org/content/63/3/362.abstract
AB The tumor programmed death ligand 1 (PD-L1) proportion score is the current method for selecting non–small cell lung cancer (NSCLC) patients for single-agent treatment with pembrolizumab, a programmed cell death 1 (PD-1) monoclonal antibody. However, not all patients respond to therapy. Better understanding of in vivo drug behavior may help in the selection of patients who will benefit the most. Methods: NSCLC patients eligible for pembrolizumab monotherapy as first- or later-line therapy were enrolled. Patients received 2 injections of 89Zr-pembrolizumab, 1 without a preceding dose of pembrolizumab and 1 with a preceding dose of 200 mg of pembrolizumab, directly before tracer injection. Up to 4 PET/CT scans were obtained after tracer injection. After imaging acquisition, patients were treated with 200 mg of pembrolizumab every 3 wk. Tumor uptake and tracer biodistribution were visually assessed and quantified as the SUV. Tumor tracer uptake was correlated with PD-1 and PD-L1 expression and response to pembrolizumab treatment. Results: Twelve NSCLC patients were included. One patient experienced grade 3 myalgia after tracer injection. 89Zr-pembrolizumab was observed in the blood pool, liver, and spleen. Tracer uptake was visualized in 47.2% of 72 tumor lesions measuring ΒΧΡ20 mm in the long-axis diameter, and substantial uptake heterogeneity was observed within and between patients. Uptake was higher in patients with a response to pembrolizumab treatment (n = 3) than in patients without a response (n = 9), although this finding was not statistically significant (median SUVpeak, 11.4 vs. 5.7; P = 0.066). No significant correlations were found with PD-L1 or PD-1 immunohistochemistry. Conclusion: 89Zr-pembrolizumab injection was safe, with only 1 grade 3 adverse event—possibly immune-related—in 12 patients. 89Zr-pembrolizumab tumor uptake was higher in patients with a response to pembrolizumab treatment but did not correlate with PD-L1 or PD-1 immunohistochemistry.