State-of-the-Art Imaging in Antibody-Drug Conjugate Treatment for Advanced Bladder Cancer

Area of Science:

• Oncology
• Radiology
• Pharmacology

Background:

• Advanced bladder cancer treatment has been revolutionized by antibody-drug conjugates (ADCs) like enfortumab vedotin and trastuzumab deruxtecan.
• These ADCs demonstrate significant efficacy in patients progressing after chemotherapy and immunotherapy.
• Imaging is integral to ADC therapy, encompassing diagnosis, staging, response assessment, recurrence detection, and toxicity evaluation.

Purpose of the Study:

• To review the pivotal role of imaging in antibody-drug conjugate (ADC)-based therapy for advanced bladder cancer.
• To highlight the evolving therapeutic landscape and the necessity for radiologists to adapt to new imaging paradigms.
• To emphasize the multidisciplinary approach required for integrating imaging with ADC treatment.

Main Methods:

• Review of current literature on ADC therapy in advanced bladder cancer.
• Discussion of imaging modalities including CT, multiparametric MRI, and FDG-PET in ADC treatment.
• Analysis of response assessment criteria (RECIST 1.1) and emerging imaging techniques.

Main Results:

• ADCs targeting Nectin-4 and HER2 show substantial efficacy in advanced bladder cancer.
• Imaging modalities like CT, MRI, and PET are essential for monitoring treatment response and toxicity.
• Resistance mechanisms and the need for next-generation ADCs are identified challenges.

Conclusions:

• Imaging is critical for optimizing patient management in ADC-based bladder cancer therapy.
• Radiologists need to stay abreast of advancements in ADC treatments and imaging techniques.
• A multidisciplinary approach integrating imaging and ADC therapy is vital for improving patient outcomes.