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Master Thesis

Comparaison de critères morphologiques et métaboliques pour l’évaluation de la réponse tumorale sous anti-PD1 dans le cancer du poumon

Abstract : Aim: The aim of this study was to evaluate the concordance of the iRECIST criteria and PERCIST and their performance for the evaluation of tumor response in patients on immunotherapy for lung cancer, and to study the atypical responses.
Methods: 46 patients treated with anti-PD1 for lung cancer and who had pre-treatment PET, then two PET scans were included between 2016 and 2018. The PERCIST criteria have been adapted to the criteria iRECIST to be comparable to them, and named iPERCIST. The dissociated metabolic and morphological responses and the metabolic and morphological pseudo-progressions were collected. Patients having received treatment for more than 6 months were considered as having a prolonged clinical benefit (PCB).
Results: At evaluation 1, the iPERCIST criteria were better than iRECIST criteria for early predicting PCB. At evaluation 2, we observed a significant discrepancy between the two criteria that had a low sensitivity to predict PCB (sensitivity 0.45, specificity 0.94 for iRECIST; sensitivity 0.62, specificity 0.82 for iPERCIST). The combined use of the 2 criteria increased the sensitivity for the prediction of the response, with a good specificity (sensitivity 0.76, specificity 0.82), and permitted to screen more non-responder patients. Among 7 patients (15.2%) with a dissociated metabolic response, 6 showed a prolonged clinical benefit. Considering the dissociated metabolic response as predictive of PCB increased the performances to predict the response to treatment (sensitivity 0.97, specificity 0.88). Morphological dissociated response, metabolic pseudo-progression, and morphological pseudo-progression didn’t have prognostic value on our population.
Conclusion: The poor positive predictive value of the first PET scan or CT on the treatment failure seems to justify the benefit of the use of adapted criteria for the evaluation of the metabolic response. The joint analysis of metabolic and morphological responses allowed categorizing patients more effectively, suggesting the potential value of a collaborative interpretation of imaging exams. In addition, we observed in our study a high frequency of dissociated responses, mostly metabolic, this response pattern seemingly specific to patients treated with anti-PD1 for lung cancer, and predictive to prolonged benefit of treatment.
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Master Thesis
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Submitted on : Friday, January 10, 2020 - 5:56:53 PM
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Margaux Poirier. Comparaison de critères morphologiques et métaboliques pour l’évaluation de la réponse tumorale sous anti-PD1 dans le cancer du poumon. Médecine humaine et pathologie. 2019. ⟨dumas-02435424⟩



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