2197P - Prognostic value of 18F-FDG-PET for patients with malignant pleural mesothelioma treated with double immunotherapy

Background

While malignant pleural mesothelioma (MPM) confers a poor prognosis, there are large differences between disease trajectories and a lack of prognostic biomarkers. With the introduction of new therapeutic options, it is essential to identify biomarkers that could aid treatment selection. The use of volumetric positron emission tomography (PET) parameters as biomarkers in cancer is becoming more prevalent. However, their application in MPM remains limited. Our study aimed to obtain volumetric PET features and assess their prognostic value.

Methods

88 patients with MPM treated with double immunotherapy in the NIPU trial were included in the analyses. Participants underwent a 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) scan at screening. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were obtained using Lesion Scout with Auto-ID in syngo.via.

Results

Median overall survival (OS), median time on treatment (TOT), and median progression-free survival (PFS) were 35, 20, and 18 weeks, respectively. The patients were divided into two subgroups based on median MTV. The group with low MTV experienced a significantly better OS, TOT, and PFS, with an HR of 4.18 (p-value < 0.001, CI 2.09 - 8.36), 2.11 (p-value 0.002, CI 1.32 - 3.37) and 2.42 (p-value < 0.001, CI 1.46 - 3.99), respectively. In multivariate analyses, MTV and TLG were significantly associated with OS, PFS, and TOT, while histology and ECOG performance status were significantly associated with OS. There was no significant association between outcomes and maximum SUV and SUV peak in univariate or multivariate analyses.

Conclusions

Our study emphasizes the prognostic value of volumetric PET features, notably MTV, over several clinical parameters in MPM, highlighting the utility of 18F-FDG-PET.

Clinical trial identification

2019-002721-30.

Editorial acknowledgement

Legal entity responsible for the study

Oslo University Hospital.

Funding

HSØ.

Disclosure

S.M.H. Thunold: Financial Interests, Personal, Invited Speaker: BMS. S.J. Farooqi: Financial Interests, Personal, Other, Arranged conference: Merck; Financial Interests, Personal, Other, Made a short film about drug compliance: Pfizer; Financial Interests, Personal, Invited Speaker: AstraZeneca, BMS; Financial Interests, Personal, Other, Made a short film about targeted treatment: Amgen; Financial Interests, Personal, Other, Made a short film about Mesothelioma: BMS; Financial Interests, Personal, Advisory Board: BMS. A. Helland: Financial Interests, Institutional, Advisory Board, Advisory boards: Jansen, Takeda, AstraZeneca, AbbVie, Roche, BMS, Pfizer, MSD, Bayer, Lilly; Financial Interests, Institutional, Invited Speaker, talks at meetings: AstraZeneca, Roche, AbbVie, Pfizer; Financial Interests, Institutional, Coordinating PI, BMS provides drug to patients in an investigator initiated clinical trial: BMS; Financial Interests, Institutional, Coordinating PI, Ultimovacs provides drug and funds for investigator initiated clinical trial: Ultimovacs; Financial Interests, Institutional, Coordinating PI, AstraZeneca provides drug and funds for investigator initiated clinical trial: AstraZeneca; Financial Interests, Institutional, Coordinating PI, Roche provides drug and funds for investigator initiated clinical trial: Roche; Financial Interests, Institutional, Coordinating PI, Novartis provides drug and funds for clinical trial: Novartis; Financial Interests, Institutional, Coordinating PI, Eli Lilly provides drug and funds for clinical study: Eli Lilly; Financial Interests, Institutional, Coordinating PI, Incyte provides drug and funds for clinical study: Incyte; Financial Interests, Institutional, Coordinating PI, Illumina provides assays for patients in a clinical trial: Illumina; Non-Financial Interests, Other, Board member in the patient organisation until 2022. Provides advice and gives talks: The lung cancer patients organisation. V.D. Haakensen: Non-Financial Interests, Institutional, Invited Speaker: AstraZeneca, BMS, Takeda; Non-Financial Interests, Institutional, Writing Engagement: AstraZeneca, BMS, Takeda; Non-Financial Interests, Institutional, Advisory Board: AstraZeneca, Pfizer. All other authors have declared no conflicts of interest.