contribution of different biomarkers for designing a therapeutic strategy in BRAF mutated melanoma

Le mélanome métastatique est resté longtemps synonyme de pronostic catastrophique en raison de la faible efficacité des traitements disponibles. Depuis quelques années, de nombreuses innovations thérapeutiques ont révolutionné la prise en charge de ces patients, avec l’autorisation de mise sur le marché de traitements modulateurs de l’immunothérapie d’une part et de thérapies ciblant la voie des MAP kinases destinées aux patients porteurs de la mutation BRAF (présente dans environ 50% des mélanomes) d’autre part.Les inhibiteurs de BRAF et de MEK sont à l’origine de réponses spectaculaires, mais le contrôle de la maladie est généralement limité dans le temps, avec l’apparition de résistances au traitement entraînant une progression de la maladie. Etablir des stratégies thérapeutiques permettant de retarder ou de contourner ces résistances s’avère donc primordial. Pour ce faire, des biomarqueurs ou outils prédictifs de la réponse, in vitro et in vivo, peuvent contribuer à mieux stratifier les patients, et personnaliser leur prise en charge.Dans une première partie, nous avons comparé l’apport respectif d’un traceur de prolifération cellulaire, la 18F-FLT, et du traceur de consommation de glucose le 18F-FDG, dans l’évaluation thérapeutique d’une xénogreffe de mélanome BRAF muté traité par un inhibiteur de BRAF. Nous avons confirmé la place prépondérante du 18F-FDG, et étayé l’intérêt des index volumiques pour le suivi thérapeutique, notamment avec la 18F-FLT.Dans une seconde partie nous avons évalué in vivo la capacité d’un schéma d’administration intermittente à retarder l’apparition de résistance par rapport à un schéma d’administration continue dans des xénogreffes BRAF mutées traitées par une combinaison d’inhibiteurs BRAF/MEK. Dans nos modèles expérimentaux, il ne semblait pas y avoir de supériorité de l’administration intermittente. Toutefois nos expérimentations n’ont pas permis de trancher de façon formelle la question.Dans une troisième partie, nous avons voulu reproduire le schéma d’administration intermittent ex vivo en utilisant la technique d’histocultures. Nous avons par ailleurs évalué la possibilité pour des histocultures issues de tumeurs de patients de prédire la réponse aux thérapies ciblées chez ces mêmes patients. Les histocultures semblent un outil fiable pour guider les choix thérapeutiques. La documentation des modifications génétiques et de l’hétérogénéité moléculaire du mélanome pourrait également inciter à adapter la stratégie en fonction de l’agressivité présumée du mélanome chez un patient donnéMetastatic melanoma has long been synonymous of dismal prognosis, due to the weak efficacy of available treatments. Numerous therapeutic innovations have profoundly modified the management of these patients, with marketing authorizations of therapies targeting the MAP Kinases pathway for patient with BRAF mutated melanoma (about 50% of patients) on the one hand and immune checkpoint inhibitors on the other hand.BRAF and MEK inhibitors result in dramatic responses, but disease control is generally short-lived, with onset of drug resistance leading to disease progression. Designing therapeutic strategies allowing delaying or bypassing this resistance phenomenon is of primary importance. Thus, in vitro and vivo biomarkers or tools predictive of response could help stratifying patients, and personalize each patient’s management.In the first part, we compared the respective value of a proliferation tracer, 18F-FLT, and of the glucose consumption tracer, 18F-FDG for therapeutic evaluation of a BRAF mutated melanoma xenograft, treated by a BRAF inhibitor. We confirmed the predominant role of 18F-FDG, and backed up the potential interest of volumetric parameters for therapeutic follow-up, especially with 18F-FLT.In a second part we assessed in vivo the ability of an intermittent schedule to delay resistance onset, compared with a continuous schedule in BRAF mutated xenografts treated by a BRAF/MEK inhibitors combination. In our experimental models, there did not seem to be any superiority for the intermittent schedule. However our experiments did not allow us to draw any final conclusions on the subject.In a third part, we tried to reproduce ex vivo the intermittent schedule with histocultures device. We also assessed the possibility for histocultures with patient derived tumours to predict response to targeted therapies in the same patients. Histocultures appear as a relevant tool to guide therapeutic choice. Determination of genetic modifications and molecular heterogeneity may also prompt tailoring therapeutic strategy depending on the supposed aggressiveness of a melanoma in a given patien

Etude d'un médicament radiopharmaceutique dans le diagnostic de l'hypoxie tumorale (le 18F-FETNIM dans le cancer du col de l'utérus)

PARIS-BIUP (751062107) / SudocSudocFranceF

18FDG PET Assessment of Therapeutic Response in Patients with Advanced or Metastatic Melanoma Treated with First-Line Immune Checkpoint Inhibitors

International audienceBackground: Immune checkpoint inhibitors (ICI) are currently the first-line treatment for patients with metastatic melanoma. We investigated the value of positron emission tomography (PET) response criteria to assess the therapeutic response to first-line ICI in this clinical context and explore the potential contribution of total tumor metabolic volume (TMTV) analysis. Methods: We conducted a retrospective study in patients treated with first-line ICI for advanced or metastatic melanoma, with 18F-FDG PET/CT performed at baseline and 3 months after starting treatment. Patients’ metabolic response was classified according to PERCIST5 and imPERCIST 5 criteria. TMTV was recorded for each examination. Results: Twenty-nine patients were included. The median overall survival (OS) was 51.2 months (IQR 13.6—not reached), and the OS rate at 2 years was 58.6%. Patients classified as responders (complete and partial response) had a 90.9% 2-year OS rate versus 38.9% for non-responders (stable disease and progressive disease) (p = 0.03), for PERCIST5 and imPERCIST 5 criteria. The median change in metabolic volume was 9.8% (IQR −59–+140%). No significant correlation between OS and changes in TMTV was found. Conclusion: The evaluation of response to immunotherapy using metabolic imaging with PERCIST5 and imPERCIST5 was significantly associated with OS in patients with advanced or metastatic melanoma

Yield of FDG PET/CT for Defining the Extent of Disease in Patients with Kaposi Sarcoma

International audienceBackground: Positron emission tomography/computed tomography with fluorodeoxyglucose (F-18) (FDG PET/CT) is increasingly used in Kaposi sarcoma (KS), but its value has not been assessed. Objectives: In this study, we aimed to evaluate the diagnostic accuracy of FDG PET/CT to define the extent of disease in KS. Methods: Consecutive patients with KS referred to our department for FDG PET/CT were included. The diagnostic accuracy of FDG PET/CT for cutaneous and extra-cutaneous KS staging was assessed on a per lesion basis compared to staging obtained from clinical examination, standard imaging, endoscopy, histological analyses, and follow-up. Results: From 2007 to 2017, 75 patients with FDG PET/CT were analyzed. The sensitivity and specificity of FDG PET/CT for the overall detection of KS lesions were 71 and 98%, respectively. Sensitivity and specificity were 100 and 85% for lymph nodes, 87 and 98% for bone, 87 and 100% for lungs, and 100 and 100% for muscle involvement, whereas sensitivity was only 17% to detect KS digestive involvement. The sensitivity of the diagnostic for KS cutaneous involvement increased from 73 to 88% when using a whole-body examination. Conclusion: FDG PET/CT showed good sensitivity and specificity for KS staging (digestive involvement excepted) and could be used for staging patients with active KS

Current and Future Role of Medical Imaging in Guiding the Management of Patients With Relapsed and Refractory Non-Hodgkin Lymphoma Treated With CAR T-Cell Therapy

International audienceChimeric antigen receptor (CAR) T-cells are a novel immunotherapy available for patients with refractory/relapsed non-Hodgkin lymphoma. In this indication, clinical trials have demonstrated that CAR T-cells achieve high rates of response, complete response, and long-term response (up to 80%, 60%, and 40%, respectively). Nonetheless, the majority of patients ultimately relapsed. This review provides an overview about the current and future role of medical imaging in guiding the management of non-Hodgkin lymphoma patients treated with CAR T-cells. It discusses the value of predictive and prognostic biomarkers to better stratify the risk of relapse, and provide a patient-tailored therapeutic strategy. At baseline, high tumor volume (assessed on CT-scan or on [18F]-FDG PET/CT) is a prognostic factor associated with treatment failure. Response assessment has not been studied extensively yet. Available data suggests that current response assessment developed on CT-scan or on [18F]-FDG PET/CT for cytotoxic systemic therapies remains relevant to estimate lymphoma response to CAR T-cell therapy. Nonetheless, atypical patterns of response and progression have been observed and should be further analyzed. The potential advantages as well as limitations of artificial intelligence and radiomics as tools providing high throughput quantitative imaging features is described

First Extensive Analysis of 18 F-Labeled Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in a Large Cohort of Patients With HIV-Associated Hodgkin Lymphoma: Baseline Total Metabolic Tumor Volume Affects Prognosis

International audiencePURPOSE 18 F-labeled fluorodeoxyglucose positron emission tomography with computed tomography (18 F-FDG PET-CT) data in HIV-associated Hodgkin lymphoma (HIV-HL) are scarcely reported. In addition to the description of the characteristics of both baseline and interim 18 F-FDG PET-CT examinations (PET1 and iPET, respectively), the aim of this study was to assess the prognostic value of PET1 and previously identified clinical parameters in this population. PATIENTS AND METHODS PET1 of 109 patients with HIV-HL, treated with doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy regimen since 2007, and 104 iPET were centrally reviewed. All the patients were enrolled in an ongoing prospective single-center cohort of HIV-associated lymphoma. RESULTS Most patients had a disseminated disease according to the Ann Arbor classification (30% stage III and 43% stage IV), with especially bone marrow and liver as extranodal localizations. After a median follow-up of 6.7 years, 12 patients relapsed (11%) and 13 died (12%). Five-year progression-free survival (PFS) was 75.1%, and 5-year overall survival was 86.1%. Median total metabolic tumor volume (TMTV) was 121.4 cm 3. The optimal TMTV cutoff identified for prognostic analysis was 527 cm 3 , with a 2-year PFS of 71% in the 20 patients with TMTV. 527 cm 3 , compared with 91% in the 89 patients with TMTV # 527 cm 3 (P 5 .004). On multivariate analysis, a high TMTV was the only parameter independently associated with PFS. CONCLUSION In this large series of HIV-HL patients with a homogeneous management, high TMTV on PET1 examination was associated with a poor prognosis

Interpretation of 2-[F-18]FDG PET/CT in Hodgkin lymphoma patients treated with immune checkpoint inhibitors

International audienceThe development of immunotherapy has revolutionized cancer treatment, improving the outcome and survival of many patients. Immune checkpoint inhibitors (ICIs), the most common form of immunotherapy, use antibodies to restore T-cells' anti-tumor activity. Immune checkpoint inhibitors are gaining ground in the therapeutic strategy across various cancers. Although widely used in solid tumors, ICIs have shown remarkable efficacy in patients with Hodgkin lymphoma. 2-[F-18]Fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET)/CT is the gold standard to stage and monitor responses in Hodgkin lymphoma. This article reviewed the use of 2-[F-18]FDG-PET/CT in patients with Hodgkin lymphoma treated with ICI, focusing on image interpretation for response monitoring and detecting adverse events

New Approaches in Characterization of Lesions Dissemination in DLBCL Patients on Baseline PET/CT

International audienceDissemination, expressed recently by the largest Euclidian distance between lymphoma sites (SDmax), appeared a promising risk factor in DLBCL patients. We investigated alternative distance metrics to characterize the robustness of the dissemination information. In 290 patients from the REMARC trial (NCT01122472), the Euclidean (Euc), Manhattan (Man), and Tchebychev (Tch) distances between the furthest lesions, firstly based on the centroid of each lesion and then directly from the two most distant tumor voxels and the Travelling Salesman Problem distance (TSP) were calculated. For PFS, the areas under the ROC curves were between 0.63 and 0.64, and between 0.62 and 0.65 for OS. Patients with high SDmax whatever the method of calculation or high SD_TSP had a significantly poorer outcome than patients with low SDmax or SD_TSP (p < 0.001 for both PFS and OS), with significance maintained in Ann Arbor advanced-stage patients. In multivariate analysis with total metabolic tumor volume and ECOG, each distance feature had an independent prognostic value for PFS. For OS, only SDmax_Tch, SDmax_Euc _Vox, and SDmax_Man _Vox reached significance. The spread of DLBCL lesions measured by the largest distance between lymphoma sites is a strong independent prognostic factor and could be measured directly from tumor voxels, allowing its development in the area of the deep learning segmentation methods