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@ARTICLE{Sachpekidis:170546,
      author       = {C. Sachpekidis$^*$ and A. Kopp-Schneider$^*$ and J. C.
                      Hassel and A. Dimitrakopoulou-Strauss$^*$},
      title        = {{A}ssessment of early metabolic progression in melanoma
                      patients under immunotherapy: an 18{F}-{FDG} {PET}/{CT}
                      study.},
      journal      = {EJNMMI Research},
      volume       = {11},
      number       = {1},
      issn         = {2191-219X},
      address      = {Heidelberg},
      publisher    = {Springer},
      reportid     = {DKFZ-2021-02000},
      pages        = {89},
      year         = {2021},
      note         = {#EA:E060#LA:E060#},
      abstract     = {The usage of immune checkpoint inhibitors (ICIs) is the
                      standard practice for the treatment of metastatic melanoma.
                      However, a significant amount of patients show no response
                      to immunotherapy, while issues on its reliable response
                      interpretation exist. Aim of this study was to investigate
                      the phenomenon of early disease progression in
                      2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission
                      tomography/computed tomography (PET/CT) in melanoma patients
                      treated with ICIs.Thirty-one patients under ICIs serially
                      monitored with 18F-FDG PET/CT were enrolled. All patients
                      exhibited progressive metabolic disease (PMD) after two
                      ICIs' cycles according to the European Organization for
                      Research and Treatment of Cancer (EORTC) criteria, and were
                      characterized as unconfirmed PMD (uPMD). They were further
                      followed with at least one PET/CT for either confirmation of
                      PMD (cPMD) or demonstration of pseudoprogression remission.
                      Patients were also evaluated with the PET Response
                      Evaluation Criteria for Immunotherapy (PERCIMT). Moreover,
                      in an attempt to investigate immune activation, the spleen
                      to liver ratios (SLRmean, SLRmax) of 18F-FDG uptake were
                      measured.Median follow up was 69.7 months [64.6-NA].
                      According to EORTC, 26/31 patients with uPMD eventually
                      showed cPMD $(83.9\%)$ and 5/31 patients showed
                      pseudoprogression $(16.1\%).$ Patients with cPMD (n = 26)
                      had a median OS of 10.9 months [8.5-NA], while those with
                      pseudoprogression (n = 5) did not reach a median OS
                      [40.9-NA]. Respectively, after application of PERCIMT, 2/5
                      patients of the pseudoprogression group were correctly
                      classified as non-PMD, reducing the uPMD cohort to 29
                      patients; eventually, 26/29 patients demonstrated cPMD
                      $(89.7\%)$ and 3/29 pseudoprogression $(10.3\%).$ One
                      further patient with pseudoprogression exhibited transient,
                      sarcoid-like, mediastinal/hilar lymphadenopathy, a known
                      immune-related adverse event (irAE). Finally, patients
                      eventually showing cPMD exhibited a significantly higher
                      SLRmean than those showing pseudoprogression after two ICIs'
                      cycles (p = 0.038).PET/CT, performed already after
                      administration of two ICIs' cycles, can identify the
                      majority of non-responders in melanoma immunotherapy. In
                      order to tackle however, the non-negligible phenomenon of
                      pseudoprogression, another follow-up PET/CT, the usage of
                      novel response criteria and vigilance over emergence of
                      radiological irAEs are recommended. Moreover, the
                      investigation of spleen glucose metabolism may offer further
                      prognostic information in melanoma patients under ICIs.},
      keywords     = {18F-FDG PET/CT (Other) / Confirmed progressive disease
                      (Other) / Immunotherapy (Other) / Metastatic melanoma
                      (Other) / Pseudoprogression (Other) / Spleen glucose
                      metabolism (Other) / Unconfirmed progressive disease
                      (Other)},
      cin          = {E060 / C060},
      ddc          = {610},
      cid          = {I:(DE-He78)E060-20160331 / I:(DE-He78)C060-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34495433},
      doi          = {10.1186/s13550-021-00832-4},
      url          = {https://inrepo02.dkfz.de/record/170546},
}