Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany.
Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.
Nat Rev Clin Oncol. 2019 Jul;16(7):442-458. doi: 10.1038/s41571-019-0169-5.
Owing to improvements in our understanding of the biological principles of tumour initiation and progression, a wide variety of novel targeted therapies have been developed. Developments in biomedical imaging, however, have not kept pace with these improvements and are still mainly designed to determine lesion size alone, which is reflected in the Response Evaluation Criteria in Solid Tumors (RECIST). Imaging approaches currently used for the evaluation of treatment responses in patients with solid tumours, therefore, often fail to detect successful responses to novel targeted agents and might even falsely suggest disease progression, a scenario known as pseudoprogression. The ability to differentiate between responders and nonresponders early in the course of treatment is essential to allowing the early adjustment of treatment regimens. Various imaging approaches targeting a single dedicated tumour feature, as described in the hallmarks of cancer, have been successful in preclinical investigations, and some have been evaluated in pilot clinical trials. However, these approaches have largely not been implemented in clinical practice. In this Review, we describe current biomedical imaging approaches used to monitor responses to treatment in patients receiving novel targeted therapies, including a summary of the most promising future approaches and how these might improve clinical practice.
由于我们对肿瘤发生和发展的生物学原理的理解有所提高，已经开发出了各种各样的新型靶向治疗方法。然而，生物医学成像的发展并没有跟上这些进步，仍然主要用于单独确定病变大小，这反映在实体瘤反应评估标准（RECIST）中。因此，目前用于评估实体瘤患者治疗反应的成像方法往往无法检测到对新型靶向药物的成功反应，甚至可能错误地提示疾病进展，这种情况称为假性进展。在治疗过程的早期区分应答者和无应答者的能力对于允许早期调整治疗方案至关重要。各种针对单一特定肿瘤特征的成像方法，如癌症特征中所述，在临床前研究中取得了成功，其中一些已在试点临床试验中进行了评估。然而，这些方法在很大程度上尚未在临床实践中实施。在这篇综述中，我们描述了目前用于监测接受新型靶向治疗的患者治疗反应的生物医学成像方法，包括对最有前途的未来方法的总结以及这些方法如何改善临床实践。
