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Updated: Jun 11, 2025

Development of a 68Gallium-Labeled D-Peptide PET Tracer for Imaging Programmed Death-Ligand 1 Expression
Published on: February 3, 2023
Preclinical antibody-PET imaging of PD-L1
Emma L Brown1, Rachel A DeWeerd1,2, Abbey Zidel1
1Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States.
Abstract:
Programmed cell death protein-1/ligand-1 (PD-1/PD-L1) blockade, including antibody therapeutics, has transformed cancer treatment. However, a major challenge in the field relates to selecting patients who are likely to respond to immune checkpoint inhibitors. Indeed, biopsy-based diagnostic tests to determine immune checkpoint protein levels do not accurately capture the inherent spatial and temporal heterogeneity of PD-L1 tumor expression. As a result, not all PD-L1-positive tumors respond to immunotherapies, and some patients with PD-L1-negative tumors have shown clinical benefits. In 2018, a first-in-human study of the clinically-approved anti-PD-L1 antibody Atezolizumab labeled with the positron emitter zirconium-89 validated the ability of positron emission tomography (PET) to visualize PD-L1 expression in vivo and predict tumor response to immunotherapy. These studies have triggered the expansion of PD-L1-targeted immunoPET to assess PD-L1 protein levels and PD-L1 expression heterogeneity in real time and across the whole tumor. First, this mini-review introduces new PD-L1 PET imaging studies of the last 4 years, focusing on the expansion of preclinical tumor models and anti-PD-L1 antibodies/antibody fragments in development. Then, the review discusses how these preclinical models and targeting agents can be utilized to study spatial and temporal heterogeneity of PD-L1 expression.
Insights
Positron emission tomography (PET) imaging visualizes Programmed cell death protein-1 ligand-1 (PD-L1) expression in real-time. This approach aids in predicting cancer immunotherapy response and understanding tumor heterogeneity.
Area of Science:
- Oncology
- Immunotherapy
- Radiochemistry
Background:
- Immune checkpoint inhibitors targeting Programmed cell death protein-1/ligand-1 (PD-1/PD-L1) have revolutionized cancer therapy.
- Accurate patient selection for PD-1/PD-L1 blockade remains a challenge due to limitations of biopsy-based diagnostics in capturing tumor heterogeneity.
- Current methods fail to fully predict response, as some PD-L1-negative tumors benefit from immunotherapy, while some PD-L1-positive tumors do not.
Purpose of the Study:
- To review recent advancements in PD-1/PD-L1 targeted positron emission tomography (PET) imaging for cancer immunotherapy.
- To highlight the expansion of preclinical models and novel anti-PD-L1 antibodies/fragments for immunoPET development.
- To discuss the utility of these tools in assessing the spatial and temporal heterogeneity of PD-L1 expression.
Main Methods:
- Review of PD-1/PD-L1 targeted immunoPET studies published in the last four years.
- Focus on preclinical tumor models and the development of anti-PD-L1 antibodies and antibody fragments for PET imaging.
- Analysis of how these imaging agents and models can address PD-L1 expression heterogeneity.
Main Results:
- The development and application of zirconium-89 labeled anti-PD-L1 antibodies have enabled in vivo visualization of PD-L1 expression.
- Expansion of preclinical models and antibody-based targeting agents for PD-L1 immunoPET.
- Demonstration of immunoPET's potential to assess real-time, whole-tumor PD-L1 heterogeneity.
Conclusions:
- PD-1/PD-L1 targeted immunoPET offers a promising strategy for non-invasive assessment of PD-L1 expression and heterogeneity.
- This technology has the potential to improve patient selection for immune checkpoint inhibitor therapy.
- Further development of preclinical models and imaging agents will enhance the clinical utility of PD-L1 immunoPET.
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