case_images: PMC10725954_01
case_images: FDG-PET first pseudoprogression : (A, D: MIP and Axial baseline), (B, E : MIP and Axial unconfirmed progressive metabolic disease (uPMD) with 28% increase in SULpeak of the main lesion, (C, F: MIP and Axial confirming a pseudoprogression (PsPD).
case_images: fimmu-14-1243208-g001.jpg
case_images: PMC10725954_01_fimmu-14-1243208-g001.jpg
case_images: f1
case_images: Axial FDG-PET/CT: assessment after cycle 3 of pembrolizumab) was in favor of unconfirmed progressive metabolic disease (uPMD) according to iPERCIST criteria with an increase of 34% in lean body mass corrected SUV peak (SULpeak) (>30%) compared to baseline ( Figure 1A  FDG-PET MIP,  Figure 1D  Axial FDG-PET/CT: initial staging), without new hypermetabolism. After 2 new cycles of pembrolizumab, a close evaluation was performed in order not to confirm or not a proven progression. The result showed a decrease in SULpeak of more than 15%, confirming a pseudoprogression (PsPD) ( Figure 1C  FDG-PET MIP,  Figure 1F  Axial FDG-PET/CT: assessement after cycle 5 of pembrolizumab).
case_images: FDG-PET second pseudoprogression : (A, D: MIP and Axial disease stable before progression), (B, E : MIP and Axial disease progression according to PERCIST criteria with 28% increase in SULpeak of the main lesion and the appearance of 2 new lesions), (C, F: MIP and Axial confirming a pseudoprogression (PsPD) with 15% decrease in SULpeak with the disappearance of the 2 new hypermetabolisms corresponding to a uPMD according to iPERCIST criteria.
case_images: fimmu-14-1243208-g002.jpg
case_images: PMC10725954_01_fimmu-14-1243208-g002.jpg
case_images: f2
case_images: Axial FDG-PET/CT). After 21 cycles of pembrolizumab, a PET scan showed a 28% increase in SULpeak of the main lesion and the appearance of 2 new lesions ( Figure 2B  FDG-PET MIP,  Figure 2E  Axial FDG-PET/CT, arrows SUVmax 6,7 and 6,9), consistent with progression according to PERCIST criteria. The early re-assessment ( Figure 2C  FDG-PET MIP,  Figure 2F  Axial FDG PET-CT) showed a further 15% decrease in SULpeak with the disappearance of the 2 new hypermetabolisms seen on the previous scan thus corresponding to a uPMD according to iPERCIST criteria. Axial FDG-PET/CT). After 34 cycles of pembrolizumab, a PET scan showed a 27% increase in SULpeak of the main lesion and the recurrence of the 2 previous lesions ( Figure 3B  FDG-PET MIP,  Figure 3E  Axial FDG-PET/CT, arrows SUVmax 5,1 and 5,8) described in  Figure 2 , consistent with progression.
case_images: FDG-PET MIP third pseudoprogression (A, D: MIP and Axial disease stable before progression), (B, E : MIP and Axial disease progression according to PERCIST criteria with 27% increase in SULpeak of the main lesion and the recurrence of the 2 previous lesions), (C, F: MIP and Axial confirming a pseudoprogression (PsPD) with a stable SULpeak with renewed disappearance of the 2 hypermetabolisms seen on the previous scan.
case_images: fimmu-14-1243208-g003.jpg
case_images: PMC10725954_01_fimmu-14-1243208-g003.jpg
case_images: f3
case_images: Axial FDG-PET/CT). After 34 cycles of pembrolizumab, a PET scan showed a 27% increase in SULpeak of the main lesion and the recurrence of the 2 previous lesions ( Figure 3B  FDG-PET MIP,  Figure 3E  Axial FDG-PET/CT, arrows SUVmax 5,1 and 5,8) described in  Figure 2 , consistent with progression. The early re-assessment showed a stable SULpeak with renewed disappearance of the 2 hypermetabolisms seen on the previous scan ( Figure 3C  FDG-PET MIP,  Figure 3F  Axial FDG-PET/CT).