18F-FDG uptake in PET/CT is a potential predictive biomarker of response to anti-PD-1 antibody therapy in non-small cell lung cancer

Abstract

To examine the association between 18F-fluorodeoxyglucose (18F-FDG) uptake in positron emission tomography/computed tomography (PET/CT) and the response to anti-programmed cell death-1 (PD-1) monoclonal antibody therapy in non-small cell lung cancer (NSCLC) patients, 89 patients with advanced or recurrent NSCLC were retrospectively analysed. Maximum standardized uptake value (SUVmax) in 18F-FDG PET/CT and the response to anti-PD-1 antibodies were recorded. A cut-off value of SUVmax was determined by receiver operating characteristic curve analysis for patient stratification. Among the 89 patients evaluated, 24 were classified as responders (all partial response), and 65 as non-responders. The average SUVmax of the responders was 15.60 (range, 6.44-51.10), which was significantly higher than that of the non-responders (11.61; range, 2.13-32.75; P = 0.0168, Student's t-test). The cut-off SUVmax value selected for stratification was 11.16 (sensitivity and specificity, 0.792 and 0.585, respectively). The response rate of patients with SUVmax value ≥ 11.16 (41.3% [19/46]) was significantly higher than that of patients with SUVmax < 11.16 (11.6% [5/43], P = 0.0012, Chi-squared test). The SUVmax in 18F-FDG PET/CT is a potential predictive marker of response to anti-PD-1 antibody therapy in NSCLC patients. Further prospective studies of large populations are necessary to validate these results.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1

SUVmax of non-responders and responders to anti-PD-1 mAb therapy. Box and whisker plot showing SUVmax of 89 NSCLC patients classified as responders (PR, n = 24) and non-responders (PD + SD, n = 65). The midline, box edges, and outer bars indicate the median, first and third quartiles, and the upper and lower whiskers, respectively. Dots represent individual patients. SUVmax, maximum standardized uptake value; PD-1, programmed cell death-1; mAb, monoclonal antibody; NSCLC, non-small cell lung cancer; PD, progressive disease; SD, stable disease; PR, partial response; CR, complete response.

Figure 2

Response rates stratified by SUVmax. (a) Receiver operating characteristic curve to determine the optimal cut-off value for SUVmax. (b) Average response rates of patients with SUVmax values above and below the cut-off. SUVmax, maximum standardized uptake value; AUC, area under curve; PD, progressive disease; SD, stable disease; PR, partial response; CR, complete response.

Figure 3

Survival of NSCLC patients stratified by SUVmax. Kaplan–Meier survival curves of progression-free survival (a) and overall survival (b) of patients stratified by SUVmax. SUVmax, maximum standardized uptake value; NSCLC, non-small cell lung cancer.