Functional Imaging of Immunotherapy: Response Criteria, Imaging Characteristics, and Novel Immunoimaging of Advanced Mal
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NUCLEAR MEDICINE & PET/CT IMAGING (R FLAVELL, SECTION EDITOR)
Functional Imaging of Immunotherapy: Response Criteria, Imaging Characteristics, and Novel Immunoimaging of Advanced Malignancies Roxanna D. Juarez1
•
Andrew Taliaferro1 • Spencer C. Behr1
Accepted: 2 September 2020 Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Immunotherapy plays a vital role in the management of patients with a subset of advanced malignancies. The mechanism of action of these novel agents has led to the development of unique imaging characteristics that are important to recognize and categorize as these can have a profound impact on patient management. Additionally, the development of novel radioactive tracers as non-invasive imaging biomarkers offer a glimpse into the future use of functional imaging. Recent Findings Immunotherapy is known to cause toxicities referred to as immune-related adverse events (irAEs). By reviewing the different response criteria used for both anatomic and metabolic imaging, while understanding the imaging characteristics of more common irAEs, one can increase the diagnostic accuracy of complex oncologic cases. Summary This article will provide a review of the mechanism of action of immunotherapy, response criteria used for diagnostic evaluation, imaging features of common irAEs, and novel immunoimaging. Keywords Immunotherapy Immune-related adverse events Positron emission tomography Response criteria Immunoimaging
This article is part of the Topical collection on Nuclear Medicine & PET/CT Imaging. & Roxanna D. Juarez [email protected] 1
Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave., S255, San Francisco, CA 94143-0628, USA
Introduction Immunomodulators have dramatically changed the medical oncology landscape [1, 2]. While first utilized in metastatic melanoma, the benefits have translated to an ever-increasing group of malignancies including advanced renal cell and non-small cell lung carcinomas [2]. The mechanism of action includes recruitment of antibodies that target immune checkpoint inhibitors (ICI) with the most common therapies relying on CTLA-4 (ipilimumab) and PD-1 inhibitors (pembrolizumab, nivolumab) [2]. These agents have demonstrated an increase in both median survival (ipilimumab) and progression-free survival (pembrolizumab/nivolumab) in patients with metastatic melanoma [1, 2]. This insures immunomodulators will play a pivotal role in the management of patients with advanced malignancies for the foreseeable future. Therefore, a thorough understanding of the unique challenges therapeutic effects may pose when interpreting imaging characteristics remains vital in helping guide patient management.
Immunomodulators Mechanism of Action Malignancy can be defined as the uncontrolled division of abnormal cells that use or disrupt a host’s normal physiological pathways to evade destruction [3••, 4]. While traditional chemoth
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