Molecular Immunology Unit, Institut Jules Bordet and Université Libre de Bruxelles, Boulevard de Waterloo, n. 127, Brussels, Belgium.
Department of Radiology, Azienda Ospedaliero Universitaria of Cagliari, SS 554 Monserrato, CA, Italy.
Crit Rev Oncol Hematol. 2017 Dec;120:13-21. doi: 10.1016/j.critrevonc.2017.09.017. Epub 2017 Oct 10.
Manipulating an individual's immune system through immune checkpoint blockade is revolutionizing the paradigms of cancer treatment. Peculiar patterns and kinetics of response have been observed with these new drugs, rendering the assessment of tumor burden particularly challenging in cancer immunotherapy. The mechanisms of action for immune checkpoint blockade, based upon engagement of the adaptive immune system, can generate unusual response patterns, including pseudoprogression, hyperprogression, atypical and delayed responses. In patients treated with immune checkpoint blockade and radiotherapy, a reduction in tumor burden at metastatic sites distant from the irradiation field (abscopal effect) has been observed, with synergistic systemic immune effects provoked by this combination. New toxicities have also been observed, due to excessive immune activity in several organs, including lung, colon, liver and endocrine glands. Efforts to standardize assessment of cancer immunotherapy responses include novel consensus guidelines derived by modifying World Health Organization (WHO) and Response Evaluation Criteria In Solid Tumors (RECIST) criteria. The aim of this review is to evaluate imaging techniques currently used routinely in the clinic and those being used as investigational tools in immunotherapy clinical trials.
通过免疫检查点阻断来操纵个体的免疫系统正在彻底改变癌症治疗的模式。这些新药表现出独特的反应模式和动力学，使得在癌症免疫治疗中评估肿瘤负担变得特别具有挑战性。基于适应性免疫系统的免疫检查点阻断的作用机制可以产生不同寻常的反应模式，包括假性进展、超进展、非典型和延迟反应。在接受免疫检查点阻断和放疗治疗的患者中，已经观察到远离照射野的转移部位的肿瘤负担减少（远隔效应），这种联合治疗引发了协同的全身免疫效应。由于几个器官（包括肺、结肠、肝和内分泌腺）的过度免疫活性，也观察到了新的毒性。为了标准化癌症免疫治疗反应的评估，包括通过修改世界卫生组织（WHO）和实体瘤反应评估标准（RECIST）标准衍生的新共识指南。本文的目的是评估目前在临床上常规使用的成像技术以及作为免疫治疗临床试验中研究工具的成像技术。
