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New PET Treatments Add Valuable Information to Brain Metastasis Monitoring

For patients with brain metastases, amino acid PET can provide valuable information about the effectiveness of state-of-the-art treatments. When treatment monitoring with contrast-enhanced MRI is unclear, adding 18F-FET PET can help to accurately diagnose recurring brain metastases and reliably assess patient response. This research was published in the Journal of Nuclear Medicine.

Newer treatment options for patients with brain metastases—such as immune checkpoint inhibitors and targeted therapies—are effective but can cause a variety of side effects. As a result, imaging findings on contrast-enhanced MRI can be highly variable, and it can be difficult to tell whether a treatment is working.

“Essentially, these new treatments have requirements of brain imaging which cannot be met by conventional MRI,” says Norbert Galldiks, MD, a professor of neurology, neurologist, and neuro-oncologist at the University Hospital Cologne and Research Center in Juelich, Germany. “In our study, we tried to determine if adding 18F-FET PET could help to overcome some of these imaging challenges.”

The retrospective study included melanoma and lung cancer patients with brain metastases who had been treated with immune checkpoint inhibitors or targeted therapy alone or in combination with radiotherapy. 18F-FET PET imaging was shown to be a useful method when conventional MRI was inconclusive. It could correctly diagnose brain metastasis relapses as well as identify patients who were responding to treatment and those who were not.

“In cases of ambiguous MRI findings, supplemental FET PET is helpful for treatment monitoring. It provides physicians with a longer time window for subsequent patient management and allows them to optimize the treatment strategy for each individual patient,” Galldiks says. “Since this approach is so accurate, it has the potential to influence clinical decision making. This may help to reduce the number of invasive procedures and limit overtreatment for a considerable number of seriously ill patients with brain metastases.”

— Source: SNMMI

Humana Partially Reverses PET/CT Non-Coverage Policy

Since November 2020, SNMMI has been in communications with Humana regarding their decision to deny coverage for PET/CT and SPECT/CT on the basis that they are “experimental/investigational” and “not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature.” (Humana Policy Number: HCS-0506-010; PET/CT CPT codes 78429-78433; SPECT/CT codes 78830, 78832.)

The latest update to Humana’s policy, which added CPT code 78433 to the list of noncovered codes, took effect February 4, 2021, and reads as follows:

“Humana members may NOT be eligible under the Plan for PET with concurrently acquired CT for any indications other than those listed above, including, but not limited to:

• cardiac indications; OR
• gastric or esophageal oncologic indications; OR
• neurologic indications; OR
• total body PET/CT (uEXPLORER) for screening (eg, cancer) …
• SPECT/CT.”

There is ample evidence in the peer-reviewed literature—as well as in clinical guidelines and appropriate use criteria—supporting the use of PET/CT and SPECT/CT. This evidence is widely accepted by payers, including the Centers for Medicare & Medicaid Services and the American Medical Association. Implementation of Humana’s revised policy would deny patients access to state-of-the-art imaging procedures that are the standard of care for supporting potentially life-saving clinical decisions.

After writing two letters to Humana, SNMMI leadership and key members met with the commercial payer on January 21, 2021, to discuss its policy decision to exclude hybrid PET/CT for certain indications and SPECT/CT from coverage. Subsequently, Humana reversed its decision to deny coverage for PET/CT imaging of gastric and esophageal oncologic indications. Humana’s medical review panel will convene again in May to decide whether to cover PET/CT for cardiac/neurologic indications and SPECT/CT. SNMMI will continue to monitor this issue and will inform the membership once a decision is reached.

A letter to Humana regarding coverage of hybrid PET/CT for cardiac indications, a separate letter pertaining to other exclusions, and a letter signed by patient groups opposing Humana’s decision have all been made available by SNMMI.

— Source: SNMMI