It remains unclear whether the accumulation of 2-deoxy-2-[¹⁸F]fluoro-d-glucose (¹⁸F-FDG) before the initiation of anti-programmed death-1 (PD-1) antibody can predict the outcome after its treatment. The aim of this study is to retrospectively examine the prognostic significance of ¹⁸F-FDG uptake as a predictive marker of anti-PD-1 antibody. Eighty-five patients with previously treated non-small cell lung cancer (NSCLC) who underwent ¹⁸F-FDG-positron emission tomography (PET) just before administration of nivolumab or pembrolizumab monotherapy were eligible in our study, and metabolic tumor volume (MTV), total lesion glycolysis (TLG) and the maximum of standardized under value (SUV_max) on ¹⁸F-FDG uptake were assessed. Objective response rate, median progression-free survival and median overall survival were 36.6%, 161 days and 716 days, respectively. The frequency of any immune-related adverse events was significantly higher in patients with low ¹⁸F-FDG uptake on PET than in those with high uptake. By multivariate analysis, the tumor metabolic activity by TLG and MTV was identified as an independent prognostic factor for predicting outcome after anti-PD-1 antibody therapy, but not SUV_max, predominantly in patients with adenocarcinoma. Metabolic tumor indices as TLG and MTV on ¹⁸F-FDG uptake could predict the prognosis after anti-PD-1 antibodies in patients with previously treated NSCLC.

Objectives: Programmed death-1(PD-1)/programmed death ligand-1 (PD-L1) antibodies have clinical benefits for cancer patients facing immune-related adverse events (irAEs). However, the effect of steroid use on the prognosis of patients with non-small cell lung cancer (NSCLC) receiving PD-1 blockade remains unclear. Methods: NSCLC patients with complete response (CR)/partial response (PR) or stable disease (SD)/not evaluable (NE) status plus progression-free survival (PFS) of 180 days after PD-1 blockade from December 2015 to December 2018 were retrospectively registered in our study and were divided into two groups: those with and without systemic steroid use for irAEs. Results: In total, 126 patients who had benefitted from PD-1 blockade were enrolled in our study; among them, 44 received systemic steroids for irAEs, and 82 had no adverse events or, if they did, did not receive systemic steroids. Among the 44 patients requiring steroids, interstitial lung disease (ILD), adrenal insufficiency, diarrhea, and liver dysfunction were observed in 19, 9, 4, and 4 patients, respectively. More side effects were observed in the group treated by steroids. The median PFS and overall survival (OS) in patients with and without systemic steroid use were 11.7 and 16.0 months (p < 0.037) and 35.0 and 41.0 months (p < 0.28), respectively. In univariate and multivariate analyses of survival, systemic steroid treatment for irAEs was significantly associated with PFS. The occurrence of ILD, adrenal insufficiency, and fever was significant in patients who used systemic steroids for irAEs. Conclusions: Patients administered systemic steroids for irAEs due to PD-1 blockade treatment exhibited shorter PFS than those who were not. Systemic steroids might affect survival after PD-1 blockade even for patients who once acquired its clinical benefit.

Background: Fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) is a useful modality for the diagnosis of various cancers; however, its role in predicting the therapeutic response to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) remains unclear. The effect of metabolic tumor activity on ¹⁸F-FDG accumulation was analyzed to evaluate the efficacy of osimertinib monotherapy in patients with non-small cell lung cancer (NSCLC) harboring activating EGFR mutations. Methods: Sixty-eight patients who underwent ¹⁸F-FDG PET prior to osimertinib initiation were enrolled in this study. The maximum and peak standardized uptake values (SUV_max and SUV_peak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) all based on ¹⁸F-FDG uptake were evaluated to predict the efficacy and clinical outcomes of osimertinib monotherapy. Results: Bone metastasis was significantly associated with high MTV and TLG values, whereas liver metastasis was associated with elevated values across all four parameters (SUV_max, SUV_peak, MTV, and TLG). Positive programmed death ligand-1 (PD-L1) expression was significantly associated with high SUV_max and SUV_peak values. The objective response rate was 61.8%, and grade 3 or higher adverse events occurred in 22.1% of the patients. There were no significant differences in the therapeutic efficacy or adverse events of osimertinib according to the uptake level of ¹⁸F-FDG. Univariate analysis identified performance status (PS) and MTV as significant predictors of progression-free survival (PFS) and overall survival (OS). Multivariate analysis of PFS identified MTV as a significant prognostic factor. Conclusions: MTV is a significant marker for predicting outcomes after osimertinib monotherapy in patients with advanced NSCLC harboring EGFR mutations.

Older patients with unresectable locally advanced non-small cell lung cancer (NSCLC) frequently receive concurrent chemoradiotherapy (CCRT) with daily low-dose carboplatin; however, real-world data on its efficacy, safety, and prognostic factors remain limited. We aimed to retrospectively evaluate the clinical outcomes of this regimen and examined whether systemic inflammation-based indices predict prognosis in this setting. We reviewed 52 consecutive patients with locally advanced NSCLC treated with first-line CCRT using daily low-dose carboplatin at three Japanese institutions between April 2007 and December 2019. The median progression-free survival (PFS) and overall survival (OS) were 11.5 and 40.1 months, respectively. Twenty patients received durvalumab as maintenance therapy. In the overall cohort, multivariate analysis identified the Glasgow Prognostic Score (GPS) as an independent predictor of PFS. A GPS of 0–1 was also associated with a significantly longer OS in univariate analysis. CCRT with daily low-dose carboplatin provided durable disease control with acceptable toxicity in older patients with unresectable stage II/III NSCLC. The GPS appears to be a simple marker for PFS in this population and may aid in pretreatment risk stratification alongside histology and consolidation strategies.

Background: Pleural mesothelioma (PM) is an aggressive malignancy with poor prognosis, and reliable prognostic biomarkers are needed to better inform clinical management. We retrospectively investigated the prognostic value of the Glasgow prognostic score (GPS), prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), body mass index (BMI), and tumor glucose metabolism measured by ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET). Methods: We retrospectively reviewed patients with PM treated with first-line platinum-pemetrexed chemotherapy at our institution (April 2007–December 2023; data cutoff, December 2024) and evaluated the prognostic value of these markers and baseline FDG-PET parameters. Results: Among 79 patients diagnosed with PM, 51 who received first-line platinum-based chemotherapy with pemetrexed were analyzed. The median age was 69 (range, 42–81) years, 78% were male, and 67% had epithelioid histology. The objective response rate (ORR) was 27.5% [95% confidence interval (CI), 17.1–40.9%], and the disease control rate (DCR) was 72.5% (95% CI, 59.1–82.9%). The median progression-free survival (PFS) and overall survival (OS) were 5.8 (95% CI, 3.4–7.8) and 21.8 (95% CI, 13.4–33.5) months, respectively. Low PNI (≤45) was significantly associated with shorter OS than high PNI (>45) (18.8 vs. 28.5 months; P=0.04) and remained an independent prognostic factor in multivariable analysis (P=0.04). For 35 patients who underwent pretreatment ¹⁸F-FDG-PET, high peak standardized uptake value (SUV_peak) (>7.73) was significantly associated with worse OS than low SUV_peak (9.1 vs. 33.6 months; P<0.001) and remained an independent predictor in the multivariable analysis (P<0.001). None of the evaluated biomarkers significantly predicted PFS. GPS, NLR, and BMI showed no significant association with survival outcomes in the univariate analysis and were therefore not included in the multivariable models. Conclusions: Low PNI and high SUV_peak significantly predicted poor OS in patients with PM treated with platinum-based chemotherapy. These factors may serve as practical prognostic indicators in this population.

Older patients with unresectable locally advanced non-small-cell lung cancer (NSCLC) frequently receive concurrent chemoradiotherapy (CCRT) with daily low-dose carboplatin; however, real-world data on its efficacy, safety, and prognostic factors remain limited. We aimed to retrospectively evaluate the clinical outcomes of this regimen and examined whether systemic inflammation-based indices predict prognosis in this setting. We reviewed 52 consecutive patients with locally advanced NSCLC treated with first-line CCRT using daily low-dose carboplatin at three Japanese institutions between April 2007 and December 2019. The median progression-free survival (PFS) and overall survival (OS) were 11.5 and 40.1 months, respectively. Twenty patients received durvalumab as consolidation therapy. In the overall cohort, multivariate analysis identified the Glasgow Prognostic Score (GPS) as an independent predictor of PFS. A GPS of 0–1 was also associated with a significantly longer OS in univariate analysis. CCRT with daily low-dose carboplatin provided durable disease control with acceptable toxicity in older patients with unresectable stage II/III NSCLC. The GPS appears to be a simple marker for PFS in this population and may aid in pretreatment risk stratification alongside histology and consolidation strategies.