{"doi":"10.2967/jnumed.124.268253","title":"[<sup>18</sup>F]F-AraG Uptake in Vertebral Bone Marrow May Predict Survival in Patients with Non–Small Cell Lung Cancer Treated with Anti-PD-(L)1 Immunotherapy","abstract":"Despite the systemic impact of both cancer and the associated immune response, immuno-PET is predominantly centered on assessment of the immune milieu within the tumor microenvironment. The aim of this study was to assess the value of [<sup>18</sup>F]F-AraG PET imaging as a noninvasive method for evaluation of system-wide immune status of patients with non–small cell lung cancer before starting immunotherapy. <b>Methods:</b> Eleven patients with advanced non–small cell lung cancer were imaged with [<sup>18</sup>F]F-AraG before starting immunotherapy. Diagnostic [<sup>18</sup>F]FDG PET/CT scans were analyzed to assess differences in the extent of disease among patients. SUV<sub>max</sub>, SUV<sub>mean</sub>, and total SUV (SUV<sub>total</sub>) from all tumor lesions, active lymph nodes, spleen, vertebral bone marrow, liver, thyroid, heart, and bowel were extracted from the baseline [<sup>18</sup>F]F-AraG scans, and discriminant and Kaplan–Meier analyses were performed to test their ability to predict patient response and overall survival. <b>Results:</b> The extent of the disease was variable in the patient cohort, but none of the [<sup>18</sup>F]FDG biomarkers associated with tumor burden (SUV<sub>max</sub>, total metabolic tumor volume, and total lesion glycolysis) was predictive of patient survival. The differences in the [<sup>18</sup>F]F-AraG and [<sup>18</sup>F]FDG distribution were observed both within and between lesions, confirming that they capture distinct aspects of the tumor microenvironment. Of the 3 SUV parameters studied, [<sup>18</sup>F]F-AraG SUV<sub>total</sub> provided a dynamic range suitable for stratifying tumors or patients according to their immune activity. [<sup>18</sup>F]F-AraG SUV<sub>total</sub> measured in the lumbar and sacral vertebrae differentiated between patients who progressed on therapy and those who did not with 90.9% and 81.8% accuracy, respectively. The Kaplan–Meier analysis revealed that patients with high [<sup>18</sup>F]F-AraG SUV<sub>total</sub> in the lumbar bone marrow had significantly lower probability of survival than those with a low signal (<i>P</i> = 0.0003). <b>Conclusion:</b> This study highlights the significance of assessing systemic immunity and indicates the potential of the [<sup>18</sup>F]F-AraG bone marrow signal as a predictive imaging biomarker for patient stratification and treatment guidance.","journal":"Journal of Nuclear Medicine","year":2024,"id":447730,"datarank":0.3411941319328025,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.04930760957450549,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.04930760957450549,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":5,"citers_with_citation_signal":2,"citers_with_endowment":2,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9599,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT04726215"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":252133,"name":"Millie Das","orcid":"0000-0001-6678-9743","position":1,"is_corresponding":false},{"id":362491,"name":"Minal Vasanawala","orcid":"0000-0001-6100-4417","position":2,"is_corresponding":false},{"id":1048660,"name":"Deepti Behl","orcid":"0000-0002-8247-5055","position":3,"is_corresponding":false},{"id":7932,"name":"Martin G. Pomper","orcid":"0000-0001-6753-3010","position":4,"is_corresponding":false},{"id":254632,"name":"Patrick M. Forde","orcid":"0000-0001-6925-6344","position":5,"is_corresponding":false},{"id":618869,"name":"Erica C. Nakajima","orcid":"0000-0001-7574-7297","position":6,"is_corresponding":false},{"id":1265847,"name":"James Sayre","orcid":"0000-0002-9620-5750","position":7,"is_corresponding":false},{"id":1265848,"name":"Bin Shen","orcid":"0009-0000-2239-9380","position":8,"is_corresponding":false},{"id":1010454,"name":"Hilda Cabrera","orcid":null,"position":9,"is_corresponding":false},{"id":1266372,"name":"Niko Del Mar","orcid":null,"position":10,"is_corresponding":false},{"id":1266373,"name":"Michele Gullen","orcid":null,"position":11,"is_corresponding":false},{"id":1266374,"name":"Michele Pierini","orcid":null,"position":12,"is_corresponding":false},{"id":275911,"name":"Laura A. Cox","orcid":"0000-0002-8836-3783","position":13,"is_corresponding":false},{"id":1265849,"name":"Ojaswita Lokre","orcid":"0009-0005-9816-1906","position":14,"is_corresponding":false},{"id":779509,"name":"Timothy Perk","orcid":"0000-0002-9906-5087","position":15,"is_corresponding":false},{"id":1261402,"name":"Hee-Don Chae","orcid":null,"position":16,"is_corresponding":false},{"id":699543,"name":"Jelena Levi","orcid":"0000-0002-0846-0795","position":0,"is_corresponding":true}],"reference_count":43,"raw_metadata":null,"created_at":"2026-07-19T02:02:03.354708Z","pmid":"39448270","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}