Granzyme B PET Imaging Predicts Response to Immunotherapy in a Diet-Induced Obesity Model of Breast Cancer.

The effects of obesity on cancer treatment efficacy remain unclear, as both beneficial and detrimental modulations of the tumor immune microenvironment have been reported. We compared (68)Ga-NOTA-GZP (βAla-Gly-Gly-Ile-Glu-Phe-Asp-CHO) PET images with those obtained with the gold standard, (18)F-FDG PET, to quantify biologic variations in a diet-induced obesity model of triple-negative breast cancer to understand how obesity influences the tumor immune landscape and response to immunotherapy. Methods: C57BL6/J mice were fed a high-fat diet (n = 24) or low-fat diet (n = 18) for 14 wk. EO771 tumor-bearing mice were treated with a fixed or weight-based dose of saline or checkpoint-blockade immunotherapy, and tumor volume was evaluated for long-term response. Mice were imaged via (68)Ga-NOTA-GZP PET on day 7 to quantify immune activation, and those images were compared with (18)F-FDG PET images to characterize changes in glucose metabolism on days 0 and 6. SUV was quantified from imaging data, and a cohort of mice was euthanized to validate biologic changes via flow cytometry. Results: Mice fed a high-fat diet demonstrated increased tumor glucose metabolism at baseline, as measured by (18)F-FDG PET. No significant differences were observed in (18)F-FDG SUV for responder tumors on day 6. The (68)Ga-NOTA-GZP PET signal was increased in tumors responsive to immunotherapy on day 7 and was highly sensitive in predicting response via analysis of receiver-operating-characteristic curves. Conclusion: Obesity decreases response to immunotherapy by altering metabolism and the tumor immune microenvironment. (68)Ga-NOTA-GZP PET imaging is a sensitive and predictive imaging biomarker of immunotherapy response, but weight-based dosing is needed to achieve effective changes in tumor volume.