False positive FDG uptake in melanoma patients treated with talimogene laherparepvec (T-VEC)

Evalyn E.A.P. Mulder*, Emma H.A. Stahlie, Daniëlle Verver, Clara Lemstra, Lukas B. Been, Antien L. Mooyaart, Tessa Brabander, Erik Vegt, Frederik A. Verburg, Astrid A.M. van der Veldt, Cornelis Verhoef, Alexander C.J. van Akkooi, Dirk J. Grünhagen

*Corresponding author for this work

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Talimogene laherparepvec (T-VEC) is a genetically modified herpes simplex virus-1-based oncolytic immunotherapy and has been approved for the local treatment of unresectable (stage IIIB/C and IVM1a) cutaneous melanoma. During T-VEC treatment, tumor response is often evaluated using [18F]2-fluoro-2-deoxy- d-glucose(FDG) positron emission tomography/computed tomography (PET/CT). In a Dutch cohort (n = 173), almost one-third of patients developed new-onset FDG uptake in uninjected locoregional lymph nodes during T-VEC. In 36 out of 53 (68%) patients with new nodal FDG uptake, nuclear medicine physicians classified this FDG uptake as “suspected metastases” without clinical or pathological confirmation in the majority of patients. These false positive results indicate that new-onset FDG uptake in locoregional lymph nodes during T-VEC treatment does not necessarily reflect progressive disease, but may be associated with immune infiltration. In current clinical practice, physicians should be aware of the high false positive rate of FDG uptake during treatment with T-VEC in patients with melanoma. Therefore, pathological examination of lymph node lesions with new FDG uptake is recommended to differentiate between progressive disease and immune infiltration after treatment with T-VEC.

Original languageEnglish
Pages (from-to)1161-1165
Number of pages5
JournalJournal of Surgical Oncology
Issue number7
Publication statusPublished - 1 Dec 2021

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© 2021 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC.


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