Outcome prediction based on [18F]FDG PET/CT in patients with pleural mesothelioma treated with ipilimumab and nivolumab +/- UV1 telomerase vaccine

Solfrid Thunold; Eivor Hernes; Saima Farooqi; Åsa Kristina Öjlert; Roslyn J Francis; Anna K Nowak; Weronika Maria Szejniuk; Søren Steen Nielsen; Susana Cedres; Marc Simo Perdigo; Jens Benn Sørensen; Carin Meltzer; Lars Tore Gyland Mikalsen; Åslaug Helland; Eirik Malinen; Vilde Drageset Haakensen

doi:10.1007/s00259-024-06853-0

Outcome prediction based on [18F]FDG PET/CT in patients with pleural mesothelioma treated with ipilimumab and nivolumab +/- UV1 telomerase vaccine

Eur J Nucl Med Mol Imaging. 2024 Aug 12. doi: 10.1007/s00259-024-06853-0. Online ahead of print.

Authors

Solfrid Thunold^{1

2}, Eivor Hernes³, Saima Farooqi^{4

5}, Åsa Kristina Öjlert^{4

5}, Roslyn J Francis^{6

7}, Anna K Nowak^{7

8

9}, Weronika Maria Szejniuk^{10

11}, Søren Steen Nielsen¹², Susana Cedres¹³, Marc Simo Perdigo¹⁴, Jens Benn Sørensen^{15

16}, Carin Meltzer³, Lars Tore Gyland Mikalsen^{17

18}, Åslaug Helland^{4

5

19}, Eirik Malinen^{20

21}, Vilde Drageset Haakensen^{4

5

19}

Affiliations

¹ Dept of Oncology, Oslo University Hospital, Oslo, Norway. solthu@ous-hf.no.
² Dept of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway. solthu@ous-hf.no.
³ Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
⁴ Dept of Oncology, Oslo University Hospital, Oslo, Norway.
⁵ Dept of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
⁶ Dept of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
⁷ Medical School of The University of Western Australia, Perth, Australia.
⁸ National Centre for Asbestos-Related Diseases, University of Western Australia, Perth, Australia.
⁹ Medical Oncology, Sir Charles Gairdner Hospital, Perth, Australia.
¹⁰ Clinical Cancer Research Center & Department of Oncology, Aalborg University Hospital, Aalborg, Denmark.
¹¹ Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
¹² Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark.
¹³ Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
¹⁴ Dept of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
¹⁵ Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
¹⁶ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹⁷ Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
¹⁸ Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway.
¹⁹ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
²⁰ Dept of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
²¹ Department of Physics, University of Oslo, Oslo, Norway.

PMID: 39133306
DOI: 10.1007/s00259-024-06853-0

Abstract

Purpose: The introduction of immunotherapy in pleural mesothelioma (PM) has highlighted the need for effective outcome predictors. This study explores the role of [18F]FDG PET/CT in predicting outcomes in PM treated with immunotherapy.

Methods: Patients from the NIPU trial, receiving ipilimumab and nivolumab +/- telomerase vaccine in second-line, were included. [18F]FDG PET/CT was obtained at baseline (n = 100) and at week-5 (n = 76). Metabolic tumour volume (MTV) and peak standardised uptake value (SUV_peak) were evaluated in relation to survival outcomes. Wilcoxon rank-sum test was used to assess differences in MTV, total lesion glycolysis (TLG), maximum standardised uptake value (SUV_max) and SUV_peak between patients exhibiting an objective response, defined as either partial response or complete response according to the modified Response Criteria in Solid Tumours (mRECIST) and immune RECIST (iRECIST), and non-responders, defined as either stable disease or progressive disease as their best overall response.

Results: Univariate Cox regression revealed significant associations of MTV with OS (HR 1.36, CI: 1.14, 1.62, p < 0.001) and PFS (HR 1.18, CI: 1.03, 1.34, p = 0.02), while multivariate analysis showed a significant association with OS only (HR 1.35, CI: 1.09, 1.68, p = 0.007). While SUV_peak was not significantly associated with OS or PFS in univariate analyses, it was significantly associated with OS in multivariate analysis (HR 0.43, CI: 0.23, 0.80, p = 0.008). Objective responders had significant reductions in TLG, SUV_max and SUV_peak at week-5.

Conclusion: MTV provides prognostic value in PM treated with immunotherapy. High SUV_peak was not associated with inferior outcomes, which could be attributed to the distinct mechanisms of immunotherapy. Early reductions in PET metrics correlated with treatment response.

Study registration: The NIPU trial (NCT04300244) is registered at clinicaltrials.gov. https://classic.

Clinicaltrials: gov/ct2/show/NCT04300244?cond=Pleural+Mesothelioma&cntry=NO&draw=2&rank=4.

Keywords: Immunotherapy; MTV; Pleural mesothelioma; SUV; Telomerase vaccine; [18F]FDG PET.

Associated data

ClinicalTrials.gov/NCT04300244

Abstract

Associated data

Grants and funding