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FDG PET/CT for Assessment of Immune Therapy: Opportunities and Understanding Pitfalls
Steve Y Cho1, Daniel T Huff2, Robert Jeraj3
1University of Wisconsin Carbone Cancer Center, Madison, WI; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Abstract:
Immune checkpoint blockade has demonstrated the ability to modulate the immune system to produce durable responses in a wide range of cancers and has significantly impacted the standard of care. However, many cancer patients still do not respond to immune checkpoint blockade or have a limited duration of antitumor responses. Moreover, immune-related adverse events caused by immune checkpoint blockade can be severe and debilitating for some patients, limiting continuation of therapy and resulting in severe autoimmune conditions. Standard-of-care conventional anatomic imaging modalities and tumor response criteria have limitations to adequately assess tumor responses, especially early in the course of therapy, for risk-adapted clinical management to inform care of patients treated with immunotherapy. Molecular imaging with position emission tomography (PET) provides a noninvasive functional biomarker of tumor response, and of immune activation, for patients on immune-based therapies to help address these needs. 18F-FDG (FDG) PET/CT is readily available clinically and a number of studies have evaluated the use of this agent for assessment of prognosis, treatment response and immune activation for patients treated with immune checkpoint blockade. In this review paper, we discuss the current oncologic applications and imaging needs of cancer immunotherapy, recent studies applying FDG PET/CT for tumor response assessment, and evaluation of immune-related adverse events for improving clinical management. We largely focus on metastatic melanoma; however, we generalize where applicable to immunotherapy in other tumor types. We also briefly discuss PET imaging and quantitation as well as emerging non-FDG PET imaging radiotracers for cancer immunotherapy imaging.
Insights
Immune checkpoint blockade shows promise in cancer treatment but has limitations. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) offers a way to assess treatment response and immune activation in patients receiving immunotherapy.
Area of Science:
- Oncology
- Immunology
- Radiology
Background:
- Immune checkpoint blockade (ICB) has revolutionized cancer care, yet many patients lack durable responses or experience severe immune-related adverse events.
- Current imaging methods struggle to accurately assess early tumor response to immunotherapy, hindering risk-adapted management.
- Molecular imaging, particularly positron emission tomography (PET), offers a functional biomarker for evaluating tumor response and immune activation during immunotherapy.
Purpose of the Study:
- To review the current landscape of cancer immunotherapy and associated imaging needs.
- To discuss the application of 18F-FDG PET/CT in assessing tumor response and immune activation in patients undergoing ICB.
- To explore the role of FDG PET/CT in managing immune-related adverse events and to briefly touch upon emerging PET tracers.
Main Methods:
- Literature review focusing on studies utilizing FDG PET/CT for cancer immunotherapy assessment.
- Analysis of current oncologic applications and imaging requirements for immunotherapies.
- Discussion of FDG PET/CT's utility in evaluating treatment response, prognosis, and immune-related adverse events, with a focus on metastatic melanoma but applicable to other cancers.
Main Results:
- FDG PET/CT is a valuable tool for noninvasively assessing tumor response and immune activation in patients treated with ICB.
- FDG PET/CT can aid in early detection of treatment efficacy and potentially in monitoring immune-related adverse events.
- The review highlights the growing importance of functional imaging in optimizing cancer immunotherapy management.
Conclusions:
- FDG PET/CT plays a crucial role in evaluating the effectiveness of cancer immunotherapy and managing treatment-related toxicities.
- Molecular imaging with FDG PET/CT addresses limitations of conventional imaging, improving clinical decision-making for immunotherapy.
- Further research into PET imaging, including novel radiotracers, is essential for advancing the field of immuno-oncology imaging.
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