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Smit J, Borm FJ, Niemeijer ALN, Huisman MC, Hoekstra OS, Boellaard R, Oprea-Lager DE, Vugts DJ, van Dongen GA, de Wit-van der Veen BJ, Thunnissen E, Smit EF, de Langen AJ. PD-L1 PET/CT imaging with radiolabeled durvalumab in patients with advanced stage non-small cell lung cancer. J Nucl Med 2021; 63:686-693. [PMID: 34385342 DOI: 10.2967/jnumed.121.262473] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Better biomarkers are needed to predict treatment outcome in NSCLC patients treated with anti PD-(L)1 checkpoint inhibitors. PD-L1 immunohistochemistry has limited predictive value, possibly due to tumor heterogeneity of PD-L1 expression. Noninvasive PD-L1 imaging using 89Zr-durvalumab might provide a better reflection of tumor PD-L1 expression and can therefore support treatment decision making. Patients and Methods: NSCLC patients eligible for second line immunotherapy treatment were enrolled. Patients received two injections of 89Zr-durvalumab; one without a preceding dose of unlabeled durvalumab ('tracer dose only') and one with a preceding dose of 750 mg durvalumab, directly prior to tracer injection. Up to four PET/CT scans were obtained after tracer injection. Post-imaging acquisition, patients were treated with 750mg durvalumab every two weeks. Tracer biodistribution and tumor uptake were visually assessed and quantified as standardized uptake value (SUV) and both imaging acquisitions were compared. Tumor tracer uptake was correlated with PD-L1 expression and clinical outcome, defined as treatment response to durvalumab treatment. Results: Thirteen patients were included and ten completed all scheduled PET scans. No tracer related adverse events were observed and all patients started durvalumab treatment. Biodistribution analysis showed 89Zr-durvalumab accumulation in the blood pool, liver and spleen. Serial imaging showed that image acquisition 120 hours post injection delivered the best tumor to blood pool ratio. Most tumor lesions were visualized with the tracer-dose only versus the co-injection imaging acquisition (25% vs 13.5% of all lesions). Uptake heterogeneity was observed within (range SUVpeak 0.2 to 15.1) and between patients. Tumor uptake was higher in patients with treatment response or stable disease, compared to patients with disease progression according to RECIST 1.1. However, this difference was not statistically significant (median SUVpeak 4.9 vs 2.4, P = 0.06). SUVpeak correlated better with the combined tumor and immune cell PD-L1 score than with PD-L1 expression on tumor cells, although both were not statistically significant (P = 0.06 and P = 0.93, respectively). Conclusion: 89Zr-durvalumab was safe without any tracer related adverse events and more tumor lesions were visualized using the tracer dose only imaging acquisition. 89Zr-durvalumab tumor uptake was higher in patients with response to durvalumab treatment, but did not correlate with tumor PD-L1 IHC.
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Affiliation(s)
- Jasper Smit
- Department of Thoracic Oncology, NKI-AvL, Amsterdam, the Netherlands, Netherlands
| | - Frank Johannes Borm
- Department of Thoracic Oncology, NKI-AvL, Amsterdam, the Netherlands, Netherlands
| | - Anna-Larissa N Niemeijer
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam University Medical Centers (location VU University Medical Center),, Netherlands
| | - Marc C Huisman
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers (location VU University Medical Center)
| | - Otto S Hoekstra
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers (location VU University Medical Center)
| | - Ronald Boellaard
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers (location VU University Medical Center)
| | - Daniela Elena Oprea-Lager
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers (location VU University Medical Center)
| | - Danielle J Vugts
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers (location VU University Medical Center)
| | - Guus Ams van Dongen
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers (location VU University Medical Center)
| | | | - Erik Thunnissen
- Department of Pathology, Cancer Center Amsterdam, Amsterdam University Medical Centers (location VU University Medical Center, Netherlands
| | - Egbert F Smit
- Department of Thoracic Oncology, NKI-AvL, Amsterdam, the Netherlands, Netherlands
| | - Adrianus J de Langen
- Department of Thoracic Oncology, NKI-AvL, Amsterdam, the Netherlands, Netherlands
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Borm FJ, De Langen AJ. 18F-FDG PET/CT to predict tumor PD-L1 expression and response to PD-(L)1 blockade in patients with non-small-cell lung cancer. J Thorac Dis 2020; 12:3883-3885. [PMID: 32802470 PMCID: PMC7399425 DOI: 10.21037/jtd.2020.03.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Frank Johannes Borm
- Department of Thoracic Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Adrianus Johannes De Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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