73 PD-1/PD-L1 PET imaging: A novel tool to optimize immunotherapy? Figure 1. Examples of PET/CT images of four patients illustrating [89Zr]Zr-atezolizumab tumor uptake in five different locations on day 7 post-injection (white arrows indicate tumor lesions; PET scans were performed once per patient and time point). Images (i) and (ii) are from the same patient, whereas images (iii), (iv), and (v) are from a separate patient each. From: Bensch F, van der Veen EL, Lub-de Hooge MN, et al.53 with permission. Figure 2. PET/CT images of lesions of three patients with heterogeneous [89Zr]-atezolizumab uptake between lesions on day 7 post-injection (PET scans were performed once per patient and time point). Mediastinal lesion of a NSCLC patient (SUVmax 19.9) (left), an abdominal wall metastases of a bladder cancer patient (SUVmax 36.4) (middle), and a bone metastasis of a triple negative breast cancer patient (SUVmax 7.1) (right). From: Bensch F, van der Veen EL, Lub-de Hooge MN, et al.53 with permission. Finally, Niemeijer and colleagues53 reported clinical PET imaging data with [18F]F-anti-PD-L1 adnectin (BMS-986192) in patients with advanced NSCLC. Patients received 3 MBq/kg [18F]F-BMS986192 (specific activity ≥6.1 GBq/mmol) and a PET scan was acquired at 1 hour post injection. SUVpeak for lesions with ≥50% tumor PD-L1 expression was significantly higher compared with lesions with less than 50% tumor PD-L1 expression, according to IHC (8.2 vs 2.9, p=.018). Visual [18F]-BMS-986192 uptake heterogeneity was observed both between and within patients. Again, SUVpeak for responding lesions was higher than nonresponding lesions (median 6.5 vs 3.2, p= .03). 4
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