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The Advantages and Challenges of Using FDG PET/CT for Response Assessment in Melanoma in the Era of Targeted Agents and Immunotherapy

  • Annie N. M. Wong
  • Grant A. McArthur
  • Michael S. Hofman
  • Rodney J. Hicks
Review Article

Abstract

The treatment of melanoma has been revolutionised in recent years by advances in the understanding of the genomic landscape of this disease, which has led to the development of new targeted therapeutic agents, and the ability to therapeutically manipulate the immune system through inhibition of cancer cell-T-cell interactions that prevent an adaptive immune response. While these therapeutic interventions have dramatically improved the prospects of survival for patients with advanced melanoma, they bring significant complexity to the interpretation of therapeutic response because their mechanisms and temporal profile of response vary considerably. In this review, we discuss the mode of action of these emerging therapies and their toxicities to provide a framework for the use of FDG PET/CT in therapeutic response assessment. We propose that the greatest utility of PET in assessment of response to agents that abrogate signalling related to BRAF mutation is for early assessment of resistance, while in anti-CTLA4 therapy, immunological flare can compromise early assessment of response but can identify potentially life-threatening autoimmune reactions. For anti-PD1/PDL1 therapy, the role of FDG PET/CT is more akin to its use in other solid malignancies undergoing treatment with conventional chemotherapy. However, further research is required to optimise the timing of scans and response criteria in this disease.

Keywords

Melanoma Therapeutic monitoring PET Immune response BRAF 

Notes

Compliance with ethical standards

This review does not report any previously unpublished studies with human participants or animals performed by any of the authors. Therefore, ethics committee approval is not applicable.

Funding

Professor Hicks is a National Health and Medical Research (NHMRC) Practitioner Fellow supported by grant APP110850 and both Professor Hicks and Professor McArthur are recipients of a NHMRC program grant (APP1053792), which supports their research.

Conflicts of interest

None of the authors has a conflict of interest to report.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Annie N. M. Wong
    • 1
    • 2
  • Grant A. McArthur
    • 1
    • 2
  • Michael S. Hofman
    • 3
  • Rodney J. Hicks
    • 2
    • 3
  1. 1.Cancer MedicineThe Peter MacCallum Cancer CentreMelbourneAustralia
  2. 2.The Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneAustralia
  3. 3.Cancer imagingThe Peter MacCallum Cancer CentreMelbourneAustralia

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