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Tumor response assessment on imaging following immunotherapy
Antonia M Berz1,2, Clarisse Dromain1, Naïk Vietti-Violi1
1Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland.
Frontiers in Oncology
|November 17, 2022
Summary
Immune checkpoint inhibitors (ICIs) offer durable cancer control but require new imaging criteria to interpret unique response patterns like pseudoprogression. This review covers morphologic and metabolic imaging criteria for assessing immunotherapy response and progression.
Area of Science:
- Oncology
- Radiology
- Immunology
Background:
- Systemic immunotherapies, including immune checkpoint inhibitors (ICIs), have advanced cancer treatment, offering durable disease control and survival benefits for many patients.
- Unique response patterns such as pseudoprogression and hyperprogression occur with immunotherapies, necessitating specialized assessment beyond traditional RECIST 1.1 criteria.
Purpose of the Study:
- To review the distinct imaging patterns of tumor response and progression observed with immunotherapies.
- To provide an overview of the available imaging response criteria developed for evaluating patients treated with immunotherapies.
Main Methods:
- Review of five morphologic criteria: immune-related response criteria (irRC), immune-related RECIST (irRECIST), immune RECIST (iRECIST), immune-modified RECIST (imRECIST), and intra-tumoral RECIST (itRECIST).
- Discussion of four metabolic criteria using 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT): PECRIT, PERCIMT, imPERCIST5, and iPERCIST.
- Exploration of potential imaging biomarkers, including standardized uptake value (SUV)max and radiotracers targeting PD-L1.
Main Results:
- Morphologic criteria have been updated to account for immunotherapy-specific response patterns, including requirements for confirmatory imaging and revised definitions of progression.
- Metabolic assessment using 18F-FDG-PET/CT offers a promising complementary approach to morphologic evaluation.
- Emerging techniques like human intratumoral immunotherapy (HIT-IT) further underscore the importance of accurate imaging assessment.
Conclusions:
- Standardized imaging criteria are crucial for accurately interpreting response and progression in patients undergoing immunotherapy.
- The development and application of specialized morphologic and metabolic criteria are essential for optimizing treatment assessment and patient management in the era of cancer immunotherapy.
