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Interesting Images

18F-FDG PET/CT in Relapsed Endometrial Cancer Treated with Preoperative PD-1 Inhibitor Dostarlimab

by
Romain-David Seban
1,2,*,
Anne Donnadieu
3,
Gabrielle Journo
4,
Francois-Clement Bidard
3,5,
Capucine Richard
1,
Roman Rouzier
6 and
Laurence Champion
1,2
1
Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210 Saint-Cloud, France
2
Laboratoire d’Imagerie Translationnelle en Oncologie, Inserm, Institut Curie, 91401 Orsay, France
3
Department of Medical Oncology, Institut Curie, PSL Research University, 92210 Saint-Cloud, France
4
Department of Medical Imaging, Institut Curie, 92210 Saint-Cloud, France
5
Circulating Tumor Biomarkers Laboratory, SiRIC, Institut Curie, PSL Research University, 75005 Paris, France
6
Department of Surgery, Institut Curie, PSL Research University, 92210 Saint-Cloud, France
*
Author to whom correspondence should be addressed.
Diagnostics 2021, 11(8), 1353; https://doi.org/10.3390/diagnostics11081353
Submission received: 8 July 2021 / Revised: 24 July 2021 / Accepted: 25 July 2021 / Published: 28 July 2021
(This article belongs to the Special Issue Imaging of Gynecological Disease)
Browse Figure
Versions Notes

Abstract

:
Dostarlimab is an immune checkpoint inhibitor (ICI) targeting the Programmed-Death-1 (PD-1) co-receptor, recently approved by the European Medicines Agency (EMA) and the Food and Drug Administration (FDA) as a novel therapy for recurrent or advanced endometrial cancer. We report the case of a 64-year-old woman, experiencing vaginal recurrence with microsatellite instability high/hypermutated of a FIGO stage IA grade 2 endometrial endometrioid adenocarcinoma. She received preoperative chemotherapy with four cycles of carboplatin plus paclitaxel, with stable disease on pelvic magnetic resonance imaging (MRI) and fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT). Dostarlimab (500 mg intravenously every 3 weeks) was then introduced. The subsequent evaluation after three perfusions demonstrated a complete metabolic response on 18F-FDG PET/CT according to immunotherapy-modified PET response criteria in solid tumors (imPERCIST) criteria, then confirmed by MRI according to immune response evaluation criteria in solid tumors (iRECIST). This clinical description suggests that 18F-FDG PET/CT might take place among available tools for guiding the preoperative management for recurrent endometrial cancer patients receiving dostarlimab immunotherapy that should be further explored through clinical trials.

In this case (Figure 1), 18F-FDG PET/CT highlighted the tumor resistance to platinum-based chemotherapy and it also revealed its remarkable sensitivity to immunotherapy with dostarlimab. This rare description highlights the utility of 18F-FDG PET/CT for guiding the preoperative management for recurrent endometrial cancer patients using PET-based immune-related response criteria [1,2].
The very recent literature reports that dostarlimab monotherapy (TSR-042) is associated with significant antitumor activity and promising response rates for relapsed endometrial cancer patients [3,4], especially those with deficient mismatch mutation repair (MMR) [5] or MSI-H [6].
Given this update on the evolving role of immunotherapy as treatment of patients with recurrent endometrial cancer [7,8], we strongly believe that 18F-FDG PET/CT might take a place among available tools for a reliable strategy to manage preoperative therapy and should be further explored through clinical trials evaluating the clinical benefit with dostarlimab.

Author Contributions

Conceptualization—R.-D.S.; software—R.-D.S.; validation—R.-D.S., L.C. and A.D.; investigation—R.-D.S., A.D. and G.J.; writing—original draft preparation, R.-D.S.; writing—review and editing, R.-D.S., F.-C.B., C.R. and L.C.; supervision—R.R. and L.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The IRB of our institution waived the need for patient consent form for this retrospective study. The study was conducted in compliance with the Declaration of Helsinki.

Informed Consent Statement

The IRB of our institution waived the need for patient consent form for this retrospective study (“rule of non-opposition”).

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Decazes, P.; Bohn, P. Immunotherapy by Immune Checkpoint Inhibitors and Nuclear Medicine Imaging: Current and Future Applications. Cancers 2020, 12, 371. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  2. Leon-Mateos, L.; Garcia-Velloso, M.J.; García-Figueiras, R.; Rodriguez-Moreno, J.F.; Vercher-Conejero, J.L.; Sánchez, M.; Perez Gracia, J.L.; Simo-Perdigo, M.; Gorospe, L. A Multidisciplinary Consensus on the Morphological and Functional Responses to Immunotherapy Treatment. Clin. Transl. Oncol. 2021, 23, 434–449. [Google Scholar] [CrossRef] [PubMed]
  3. Markham, A. Dostarlimab: First Approval. Drugs 2021. [Google Scholar] [CrossRef]
  4. Kasherman, L.; Ahrari, S.; Lheureux, S. Dostarlimab in the Treatment of Recurrent or Primary Advanced Endometrial Cancer. Future Oncol. 2021, 17, 877–892. [Google Scholar] [CrossRef] [PubMed]
  5. Oaknin, A.; Tinker, A.V.; Gilbert, L.; Samouëlian, V.; Mathews, C.; Brown, J.; Barretina-Ginesta, M.-P.; Moreno, V.; Gravina, A.; Abdeddaim, C.; et al. Clinical Activity and Safety of the Anti-Programmed Death 1 Monoclonal Antibody Dostarlimab for Patients With Recurrent or Advanced Mismatch Repair-Deficient Endometrial Cancer: A Nonrandomized Phase 1 Clinical Trial. JAMA Oncol. 2020, 6, 1766–1772. [Google Scholar] [CrossRef] [PubMed]
  6. Green, A.K.; Feinberg, J.; Makker, V. A Review of Immune Checkpoint Blockade Therapy in Endometrial Cancer. Am. Soc. Clin. Oncol. Educ. Book 2020, 40, 238–244. [Google Scholar] [CrossRef] [PubMed]
  7. Rubio-Pérez, J.; Hernández, R.; Hernández, T.; Doger, B.; Casado, V.; Moreno, V. Dostarlimab for the Treatment of Endometrium Cancer and Other Solid Tumors. Drugs Today 2021, 57, 187–197. [Google Scholar] [CrossRef] [PubMed]
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Diagnostics 11 01353 g001 550
Figure 1. 18F-FDG PET/CT images and axial T1 gadolinium-enhanced pelvic MRI (with fat-saturation for the left image and without for the two others, because fat-saturation technique was not available/performed) at recurrence and follow-up during chemotherapy and immunotherapy showing pathological FDG uptake (A: maximum intensity projection-MIP PET images; B: fused axial PET/CT images) and contrast enhancement (C) corresponding to the tumor lesion in the vagina (blue arrows on the MIP, white arrows on 18F-FDG PET/CT and MRI images), without any metabolic or morphologic changes under chemotherapy. After three injections of dostarlimab, a complete response was observed both on pelvic MRI and 18F-FDG PET/CT, associated with irAE (immune-related adverse event) pneumonitis, suggested by hypermetabolic peripheral reticular markings (red arrows on the MIP and 18F-FDG PET/CT images) and small ground-glass opacities (D), then confirmed by bronchoalveolar lavage.
Figure 1. 18F-FDG PET/CT images and axial T1 gadolinium-enhanced pelvic MRI (with fat-saturation for the left image and without for the two others, because fat-saturation technique was not available/performed) at recurrence and follow-up during chemotherapy and immunotherapy showing pathological FDG uptake (A: maximum intensity projection-MIP PET images; B: fused axial PET/CT images) and contrast enhancement (C) corresponding to the tumor lesion in the vagina (blue arrows on the MIP, white arrows on 18F-FDG PET/CT and MRI images), without any metabolic or morphologic changes under chemotherapy. After three injections of dostarlimab, a complete response was observed both on pelvic MRI and 18F-FDG PET/CT, associated with irAE (immune-related adverse event) pneumonitis, suggested by hypermetabolic peripheral reticular markings (red arrows on the MIP and 18F-FDG PET/CT images) and small ground-glass opacities (D), then confirmed by bronchoalveolar lavage.
Diagnostics 11 01353 g001
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MDPI and ACS Style

Seban, R.-D.; Donnadieu, A.; Journo, G.; Bidard, F.-C.; Richard, C.; Rouzier, R.; Champion, L. 18F-FDG PET/CT in Relapsed Endometrial Cancer Treated with Preoperative PD-1 Inhibitor Dostarlimab. Diagnostics 2021, 11, 1353. https://doi.org/10.3390/diagnostics11081353

AMA Style

Seban R-D, Donnadieu A, Journo G, Bidard F-C, Richard C, Rouzier R, Champion L. 18F-FDG PET/CT in Relapsed Endometrial Cancer Treated with Preoperative PD-1 Inhibitor Dostarlimab. Diagnostics. 2021; 11(8):1353. https://doi.org/10.3390/diagnostics11081353

Chicago/Turabian Style

Seban, Romain-David, Anne Donnadieu, Gabrielle Journo, Francois-Clement Bidard, Capucine Richard, Roman Rouzier, and Laurence Champion. 2021. "18F-FDG PET/CT in Relapsed Endometrial Cancer Treated with Preoperative PD-1 Inhibitor Dostarlimab" Diagnostics 11, no. 8: 1353. https://doi.org/10.3390/diagnostics11081353

APA Style

Seban, R. -D., Donnadieu, A., Journo, G., Bidard, F. -C., Richard, C., Rouzier, R., & Champion, L. (2021). 18F-FDG PET/CT in Relapsed Endometrial Cancer Treated with Preoperative PD-1 Inhibitor Dostarlimab. Diagnostics, 11(8), 1353. https://doi.org/10.3390/diagnostics11081353

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