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We investigated the value of O -(2- 18 F-fluoroethyl)-l-tyrosine ( 18 F-FET) PET for treatment monitoring of immune checkpoint inhibition (ICI) or targeted therapy (TT) alone or in combination with radiotherapy in patients with brain metastasis (BM) since contrast-enhanced MRI often remains inconclusive. Methods: We retrospectively identified 40 patients with 107 BMs secondary to melanoma ( n = 29 with 75 BMs) or non-small cell lung cancer ( n = 11 with 32 BMs) treated with ICI or TT who had 18 F-FET PET ( n = 60 scans) for treatment monitoring from 2015 to 2019. Most patients ( n = 37; 92.5%) had radiotherapy during the course of the disease. In 27 patients, 18 F-FET PET was used to differentiate treatment-related changes from BM relapse after ICI or TT. In 13 patients, 18 F-FET PET was performed for response assessment to ICI or TT using baseline and follow-up scans (median time between scans, 4.2 mo). In all lesions, static and dynamic 18 F-FET PET parameters were obtained (i.e., mean tumor-to-brain ratios [TBR], time-to-peak values). Diagnostic accuracies of PET parameters were evaluated by receiver-operating-characteristic analyses using the clinical follow-up or neuropathologic findings as a reference. Results: A TBR threshold of 1.95 differentiated BM relapse from treatment-related changes with an accuracy of 85% ( P = 0.003). Metabolic responders to ICI or TT on 18 F-FET PET had a significantly longer stable follow-up (threshold of TBR reduction relative to baseline, ≥10%; accuracy, 82%; P = 0.004). Furthermore, at follow-up, time to peak in metabolic responders increased significantly ( P = 0.019). Conclusion:  18 F-FET PET may add valuable information for treatment monitoring in BM patients treated with ICI or TT.

the journal of nuclear medicine

Treatment Monitoring of Immunotherapy and Targeted Therapy Using <sup>18</sup>F-FET PET in Patients with Melanoma and Lung Cancer Brain Metastases: Initial Experiences

Treatment Monitoring of Immunotherapy and Targeted Therapy Using 18F-FET PET in Patients with Melanoma and Lung Cancer Brain Metastases: Initial Experiences

Treatment Monitoring of Immunotherapy and Targeted Therapy Using ¹⁸F-FET PET in Patients with Melanoma and Lung Cancer Brain Metastases: Initial Experiences