[18F]Fluoro-Deoxy-Glucose positron emission tomography to evaluate lymph node involvement in patients with muscle-invasive bladder cancer receiving neoadjuvant pembrolizumab.

Autor: Marandino L; Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: laura.marandino@istitutotumori.mi.it., Capozza A; Department of Nuclear Medicine - PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Bandini M; Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Raggi D; Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Farè E; Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Pederzoli F; Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Gallina A; Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Capitanio U; Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Bianchi M; Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Gandaglia G; Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Fossati N; Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Colecchia M; Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Giannatempo P; Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Serafini G; Department of Nuclear Medicine - PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Padovano B; Department of Nuclear Medicine - PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Salonia A; Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Briganti A; Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Montorsi F; Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy., Alessi A; Department of Nuclear Medicine - PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Necchi A; Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Jazyk: angličtina
Zdroj: Urologic oncology [Urol Oncol] 2021 Apr; Vol. 39 (4), pp. 235.e15-235.e21. Date of Electronic Publication: 2020 Oct 16.
DOI: 10.1016/j.urolonc.2020.09.035
Abstrakt: Background: Data regarding the role of positron emission tomography/computed tomography (PET/CT) to stage lymph nodes in patients receiving neoadjuvant immunotherapy before radical cystectomy are lacking. The aim of this study is to evaluate the role of PET/CT to predict the pathologic lymph node involvement (LNI) in patients with MIBC receiving neoadjuvant pembrolizumab within the PURE-01 trial (NCT02736266).
Material and Methods: Three courses of pembrolizumab were administered before radical cystectomy and extended pelvic lymph node dissection in clinical T2-4aN0M0 MIBC based on contrast-enhanced CT scan. LNI was also assessed with PET/CT before and after treatment. PET/CT results were compared with histopathological findings. The ability of baseline and post-therapy PET/CT to evaluate LNI was assessed, and univariate logistic regression analyses were performed.
Results: From February 2017 to August 2019, a total of 108 patients and 105 patients had evaluable baseline and post-pembrolizumab scans, respectively. The sensitivity to detect LNI was 27% and 37.5% for pre- and post-pembrolizumab PET/CT, and specificity was 97% and 98%, respectively. In total, 4 of 7 patients (57%) showing baseline FDG-uptake had LNI vs. 11 of 101 (11%) with no baseline uptake. All but 1 of the 7 patients did not respond to pembrolizumab. Both pre- and post-pembrolizumab PET/CT significantly predicted LNI (P = 0.004 and P < 0.001) at univariate analyses. Our results warrant further validation in larger datasets.
Conclusions: PET/CT performance does not justify its use in routine practice for cN0 MIBC. However, our preliminary data revealed opportunities for the use of baseline PET/CT, within clinical trials, to optimally select patients with MIBC who are best suited for neoadjuvant immunotherapy strategies. Validation in larger datasets, as well as a cost analysis, are needed.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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