by New research suggests that imaging the tumors of patients with advanced melanoma after just one week of treatment with pembrolizumab, a type of cancer immunotherapy, may provide valuable insights into treatment response and progression-free survival. Typically, patients undergoing immunotherapy are imaged around three months after starting treatment to monitor their progress. However, a study led by Dr. Michael D. Farwell from the Hospital of the University of Pennsylvania aimed to determine if metabolic changes could be observed sooner.
The study utilized 18F-fluorodeoxyglucose (FDG) PET/CT, a common imaging technique for detecting cancer, to assess metabolic changes in tumors after only one week on therapy. According to Dr. Farwell, a metabolic flare (MF), indicated by an increase in FDG activity, is expected to be observed as immune cells infiltrate into the tumor in response to immunotherapy. As the tumor responds to therapy, the tumor cells die off, resulting in a decrease in FDG activity known as a metabolic response (MR). In non-responding patients, the tumors are expected to maintain stable metabolism.
The researchers recruited 21 patients with advanced melanoma scheduled to receive pembrolizumab to test their hypothesis. Each patient underwent FDG PET/CT imaging within four weeks prior to starting therapy and then approximately one week after the first dose of pembrolizumab. Results were excluded for two patients who did not complete both scans.
The study defined an MF as a greater than 70% increase in tumor maximum standardized uptake value (SUVMAX) and an MR as a greater than 30% decrease in tumor SUVMAX. The findings demonstrated that imaging after just one week on pembrolizumab identified metabolic changes in tumors that correlated with treatment response and progression-free survival.
Dr. Farwell emphasizes the importance of imaging at an earlier timepoint, stating that a response to immunotherapy can occur quickly, sometimes even before the three-week mark. By imaging at one week, the researchers were able to observe the response curve over a shorter interval, minimizing the chances of tumor growth in non-responding patients that could complicate the analysis.
The results of this study suggest that early imaging after one week on pembrolizumab could serve as a noninvasive imaging biomarker, providing guidance in the management of patients undergoing immunotherapy. Identifying patients who are likely to respond to treatment could help avoid unnecessary toxicity in non-responsive individuals.
Further research is needed to validate these findings and determine the optimal timepoint for imaging in immunotherapy patients. Developing a reliable and efficient means of monitoring treatment response would greatly benefit patients with advanced melanoma and other malignancies undergoing cancer immunotherapy.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
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