A Comprehensive Review of Radiomic Methodologies for Assessing Tumor Response to Immunotherapy and Combination...

Recent advances in the genetic and molecular characterization of cancer have significantly enhanced the development of immunotherapies, which bolster the host immune system's ability to recognize and target malignant cells, thereby promoting immune responses and inhibiting tumor progression and metastasis. Despite these promising developments, not all patients benefit from immunotherapy, underscoring the urgent need for reliable biomarkers to facilitate early, predictive identification of responders and non-responders. Conventional methods for evaluating treatment response, such as the World Health Organization (WHO) criteria and the Response Evaluation Criteria in Solid Tumors (RECIST), which were primarily designed for cytotoxic chemotherapy, exhibit notable limitations. These criteria may fail to detect hyperprogressive disease in a timely manner, thereby hindering optimal treatment decision-making. Recent technological advancements in imaging modalities, including CT, PET, MRI, and radiomics, have provided critical functional and metabolic insights that enhance the evaluation and prediction of responses to immunotherapy. This review consolidates the latest findings from publicly available research and WHO reports, with a particular focus on high-mortality cancer types, and examines recent developments in non-invasive methodologies for predicting and assessing the therapeutic efficacy of immunotherapy and its combination therapies.