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Table S2 from Radiomics, Tumor Volume, and Blood Biomarkers for Early Prediction of Pseudoprogression in Patients with Metastatic Melanoma Treated with Immune Checkpoint Inhibition

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posted on 2023-03-31, 22:14 authored by Lucas Basler, Hubert S. Gabryś, Sabrina A. Hogan, Matea Pavic, Marta Bogowicz, Diem Vuong, Stephanie Tanadini-Lang, Robert Förster, Ken Kudura, Martin W. Huellner, Reinhard Dummer, Matthias Guckenberger, Mitchell P. Levesque

Summary of patient outcome of the individual groups (with landmark analysis) The landmark method was applied, that is all events before 5 months were excluded. 95% confidence intervals were provided in parentheses. PP-only patients were the best performing group, with a similar outcome compared to responding patients. TPD-only patients presented a significantly worse OS of 10 vs. 30 months in the PP-only group (p=0.002, FWER=0.010). Patients with mixed PP&TPD were in between both other groups.

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University Hospital Zurich

Swiss National Fund

European Training Network MELGEN

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ARTICLE ABSTRACT

We assessed the predictive potential of positron emission tomography (PET)/CT-based radiomics, lesion volume, and routine blood markers for early differentiation of pseudoprogression from true progression at 3 months. 112 patients with metastatic melanoma treated with immune checkpoint inhibition were included in our study. Median follow-up duration was 22 months. 716 metastases were segmented individually on CT and 2[18F]fluoro-2-deoxy-D-glucose (FDG)-PET imaging at three timepoints: baseline (TP0), 3 months (TP1), and 6 months (TP2). Response was defined on a lesion-individual level (RECIST 1.1) and retrospectively correlated with FDG-PET/CT radiomic features and the blood markers LDH/S100. Seven multivariate prediction model classes were generated. Two-year (median) overall survival, progression-free survival, and immune progression–free survival were 69% (not reached), 24% (6 months), and 42% (16 months), respectively. At 3 months, 106 (16%) lesions had progressed, of which 30 (5%) were identified as pseudoprogression at 6 months. Patients with pseudoprogressive lesions and without true progressive lesions had a similar outcome to responding patients and a significantly better 2-year overall survival of 100% (30 months), compared with 15% (10 months) in patients with true progressions/without pseudoprogression (P = 0.002). Patients with mixed progressive/pseudoprogressive lesions were in between at 53% (25 months). The blood prediction model (LDH+S100) achieved an AUC = 0.71. Higher LDH/S100 values indicated a low chance of pseudoprogression. Volume-based models: AUC = 0.72 (TP1) and AUC = 0.80 (delta-volume between TP0/TP1). Radiomics models (including/excluding volume-related features): AUC = 0.79/0.78. Combined blood/volume model: AUC = 0.79. Combined blood/radiomics model (including volume-related features): AUC = 0.78. The combined blood/radiomics model (excluding volume-related features) performed best: AUC = 0.82. Noninvasive PET/CT-based radiomics, especially in combination with blood parameters, are promising biomarkers for early differentiation of pseudoprogression, potentially avoiding added toxicity or delayed treatment switch.

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