Journal Article

Is local review of positron emission tomography scans sufficient in diffuse large B‐cell lymphoma clinical trials? A CALGB 50303 analysis

Torka, Pallawi, Kelloff, Gary, Schöder, Heiko, Knopp, Michael V., Higley, Howard R., Kahl, Brad S., Friedberg, Jonathan W., Poon, David, Pederson, Levi D., Schwartz, Lawrence H., Wilson, Wyndham H., Ruppert, Amy S., Leonard, John P., Bartlett, Nancy L., Zhang, Jun

2023

Overview

Background Quantitative methods of Fluorodeoxyglucose Positron Emission Tomography (FDG‐PET) interpretation, including the percent change in FDG uptake from baseline (ΔSUV), are under investigation in lymphoma to overcome challenges associated with visual scoring systems (VSS) such as the Deauville 5‐point scale (5‐PS). Methods In CALGB 50303, patients with DLBCL received frontline R‐CHOP or DA‐EPOCH‐R, and although there were no significant associations between interim PET responses assessed centrally after cycle 2 (iPET) using 5‐PS with progression‐free survival (PFS) or overall survival (OS), there were significant associations between central determinations of iPET ∆SUV with PFS/OS. In this patient cohort, we retrospectively compared local vs central iPET readings and evaluated associations between local imaging data and survival outcomes. Results Agreement between local and central review was moderate (kappa = 0.53) for VSS and high (kappa = 0.81) for ∆SUV categories (<66% vs. ≥66%). ∆SUV ≥66% at iPET was significantly associated with PFS (p = 0.03) and OS (p = 0.002), but VSS was not. Associations with PFS/OS when applying local review vs central review were comparable. Conclusions These data suggest that local PET interpretation for response determination may be acceptable in clinical trials. Our findings also highlight limitations of VSS and call for incorporation of more objective measures of response assessment in clinical trials. In this retrospective analysis of CALGB 50303 study, Torka et al. found that associations with PFS and OS when applying local review versus central review of interim PET (iPET) were comparable? SUV = 66% at iPET was associated with PFS and OS, but visual scoring systems (VSS) were not, highlighting the limitations of VSS.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: B-cell lymphoma / Brief Communication / Clinical trials / Deauville 5‐PS / Disease-Free Survival / Fluorodeoxyglucose F18 / Humans / interim PET / International Harmonization Project criteria / Lymphocytes B / Lymphoma / Lymphoma, Large B-Cell, Diffuse - diagnostic imaging / Lymphoma, Large B-Cell, Diffuse - drug therapy / Positron emission tomography / Positron-Emission Tomography - methods / Prognosis / Retrospective Studies / Tomography / visual scoring system / ΔSUV