检测抗程序性细胞死亡 1 治疗患者的免疫相关不良事件的医学影像学
Detection of immune-related adverse events by medical imaging in patients treated with anti-programmed cell death 1.
机构信息
Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Paris, France.
Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Université Paris-Saclay, Paris, France; Gustave Roussy, Université Paris-Saclay, Institut National de la Santé et de la Recherche Médicale (INSERM), U1015, Equipe Labellisée Ligue Nationale Contre le Cancer, Villejuif, F-94805, France; Department of Radiology, Columbia University Medical Center, NYC, NY, USA.
出版信息
Eur J Cancer. 2018 Jun;96:91-104. doi: 10.1016/j.ejca.2018.03.006. Epub 2018 Apr 23.
BACKGROUND
Programmed death receptor-1 blocking antibodies (anti-PD1) are a new standard of care in many cancer types. Patients benefit from improved survival but have the risk of immune-related adverse events (irAE). We evaluated if medical imaging procedures, used for anti-tumour response assessment, can detect irAEs.
MATERIALS AND METHODS
All consecutive patients treated with anti-PD1 and with a medical imaging acquisition performed within 2 weeks with irAEs ≥2 were retrospectively included. Data were gathered from June 2014 to February 2017, and a central review was performed. The primary and secondary end-points were i) to evaluate the overall detection rate of irAEs by medical imaging and ii) to provide a comprehensive radiological description of irAEs.
RESULTS
Fifty-three patients (31 women, 22 men; average age: 61 years) were included. The primary tumour was melanoma (n = 32), lung cancer (n = 18) and other (n = 3). Patients were treated with nivolumab (n = 27) or pembrolizumab (n = 26). Of 74 medical imaging procedures analysed (ratio = 1.4 medical imaging per patient), 55 irAE were detected. The detection rate was overall: 74% (95 confidence interval: 63-84%), positron emission tomography with 18F-fludeoxyglucose integrated with computed tomography (18F-FDG PET/CT): 83% (n = 10/12), magnetic resonance imaging: 83% (n = 5/6), computed tomography scan: 79% (n = 19/24), ultrasonography: 70% (n = 19/27), standard X-rays: 40% (n = 2/5), lung/mediastinum: 100% (n = 7/7), enterocolitis: 100% (n = 8/8), hypophysitis: 100% (n = 3/3), thyroiditis: 75% (n = 15/20), hepatitis: 67% (n = 2/3), arthralgia or arthritis: 40% (n = 2/5) and pancreas: 28% (n = 2/7).
CONCLUSION
Medical imaging detected 74% of irAE in patients treated with anti-PD1. Beyond response assessment, medical imaging can detect irAE and guide towards specific management. We described the most frequent sites and patterns of imaging findings.
背景
程序性死亡受体-1 阻断抗体（抗 PD1）是许多癌症类型的新治疗标准。患者受益于改善的生存，但存在免疫相关不良事件（irAE）的风险。我们评估了用于肿瘤反应评估的医学成像程序是否可以检测到 irAE。
材料和方法
回顾性纳入了所有接受抗 PD1 治疗且在 irAE≥2 时在 2 周内进行了医学影像学检查的连续患者。数据收集于 2014 年 6 月至 2017 年 2 月，进行了中心审查。主要和次要终点为：i）评估医学影像学对 irAE 的总体检出率，ii）提供 irAE 的全面影像学描述。
结果
共纳入 53 名患者（31 名女性，22 名男性；平均年龄：61 岁）。原发病灶为黑色素瘤（n=32）、肺癌（n=18）和其他（n=3）。患者接受纳武利尤单抗（n=27）或派姆单抗（n=26）治疗。在分析的 74 项医学影像学检查中（比率=1.4 项医学影像学检查/患者），检测到 55 例 irAE。总检出率为 74%（95%置信区间：63-84%），18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG PET/CT）：83%（n=10/12），磁共振成像（MRI）：83%（n=5/6），计算机断层扫描（CT）扫描：79%（n=19/24），超声检查：70%（n=19/27），标准 X 射线：40%（n=2/5），肺/纵隔：100%（n=7/7），肠炎：100%（n=8/8），垂体炎：100%（n=3/3），甲状腺炎：75%（n=15/20），肝炎：67%（n=2/3），关节痛或关节炎：40%（n=2/5）和胰腺：28%（n=2/7）。
结论
抗 PD1 治疗患者的医学影像学检测到 74%的 irAE。除了反应评估外，医学影像学还可以检测到 irAE，并指导特定的治疗。我们描述了最常见的影像学表现部位和模式。
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