Gallium-68 NK224 PET/CT maps PD-L1 heterogeneity in non-small cell lung cancer

Gallium-68 NK224 PET/CT detected PD-L1 heterogeneity in lung cancer: biopsy-plane uptake correlated with PD-L1 score (ρ=0.80); higher uptake predicted immunotherapy response (SUVmax 5.9 vs 1.9, P=.01). Five of 12 PD-L1-negative patients had lesions above cutoff (15 of 68 lesions…

• Prospective study of 48 participants (median age 68 years; 31 men) with newly diagnosed or recurrent/metastatic non-small cell lung cancer across 52 lesions.
• Optimal biopsy-plane SUVmax cutoff of 5.6 discriminated high PD-L1 expression; whole-lesion intratumoral heterogeneity was higher than biopsy-plane (median normalized range 1.0 vs 0.4; P<.001).
• Intertumoral heterogeneity was pronounced (median SUVmax coefficient of variation 23.6% [IQR 17.9%–36.7%]).

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