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Immune-related tumour response assessment criteria: a comprehensive review
Bhanusupriya Somarouthu1, Susanna I Lee2, Trinity Urban1
11 Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Centre , Boston, MA , USA.
Abstract:
Growing emphasis on precision medicine in oncology has led to increasing use of targeted therapies that encompass a spectrum of drug classes including angiogenesis inhibitors, immune modulators, signal transduction inhibitors, DNA damage modulators, hormonal agents etc. Immune therapeutic drugs constitute a unique group among the novel therapeutic agents that are transforming cancer treatment, and their use is rising. The imaging manifestations in patients on immune therapies appear to be distinct from those typically seen with conventional cytotoxic therapies. Patients on immune therapies may demonstrate a delayed response, transient tumour enlargement followed by shrinkage, stable size, or initial appearance of new lesions followed by stability or response. These newer patterns of response to treatment have rendered conventional criteria such as World Health Organization and response evaluation criteria in solid tumours suboptimal in monitoring changes in tumour burden. As a consequence, newer imaging response criteria such as immune-related response evaluation criteria in solid tumours and immune-related response criteria are being implemented in many trials to effectively monitor patients on immune therapies. In this review, we discuss the traditional and new imaging response criteria for evaluation of solid tumours, review the outcomes of various articles which compared traditional criteria with the new immune-related criteria and discuss pseudo-progression and immune-related adverse events.
Insights
Immune therapies in oncology show unique imaging patterns, requiring new criteria like immune-related response criteria to accurately assess tumor response beyond traditional methods.
Area of Science:
- Oncology
- Radiology
- Immunotherapy
Background:
- Precision medicine drives targeted cancer therapies, including rising use of immune modulators.
- Immune therapies exhibit distinct imaging manifestations compared to conventional cytotoxic treatments.
- Novel response patterns necessitate updated imaging evaluation methods.
Purpose of the Study:
- To review traditional and novel imaging response criteria for solid tumors in oncology.
- To compare the efficacy of traditional versus immune-related response criteria.
- To discuss pseudo-progression and immune-related adverse events in patients undergoing immunotherapy.
Main Methods:
- Literature review of studies comparing traditional and immune-related response criteria.
- Analysis of imaging manifestations in patients on immune therapies.
- Discussion of pseudo-progression and immune-related adverse events.
Main Results:
- Conventional criteria (e.g., WHO, RECIST) are suboptimal for monitoring immune therapy response.
- Immune-related response criteria (e.g., irRECIST, iRECIST) are being implemented to better track tumor burden changes.
- Observed immune therapy response patterns include delayed response, transient enlargement, and new lesions followed by stability.
Conclusions:
- Newer imaging criteria are essential for accurately evaluating tumor response to immune therapies.
- Understanding immune-related adverse events and pseudo-progression is crucial for patient management.
- Standardized immune-related response criteria improve clinical trial monitoring and patient care in immuno-oncology.
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