Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; and.
J Nucl Med. 2020 Jul;61(7):943-950. doi: 10.2967/jnumed.119.234278. Epub 2020 May 22.
Immunotherapy agents are now entering the clinic in a wide array of malignancies and have provided a valuable addition to the therapeutic armamentarium. These agents enhance the global immune response by modulating the tumor microenvironment but can lead to unconventional patterns of response, challenging the conceptual framework that imaging is a robust surrogate for therapeutic efficacy. There is also increasing evidence that an effective antitumor response requires a systemic immune response in primary and secondary lymphoid tissues. However, an enhanced systemic immune response can lead to disruption of immunologic hemostasis in healthy tissues, causing adverse events. Better understanding of the complex interplay between tumoral and systemic immune response has been provided through tissue and liquid biopsy. However, the applicability of these methods is constrained by the biologic, spatial, and temporal heterogeneity of the processes involved. There is a growing interest in molecular imaging of cell-specific lineage markers of the immune system using biomolecules. However, the ongoing role of the more widely available F-FDG PET/CT for response assessment is being recognized through ongoing refinement of interpretative guidelines and emerging evidence. These noninvasive methods provide insights into the biologic basis of the global immune response to maximize potential therapeutic benefit. In this review, we aim to provide an overview of the current status of F-FDG PET/CT in the monitoring of tumoral and systemic immune response. In a companion review, the role of other imaging probes that might complement F-FDG PET/CT will be discussed.
免疫疗法药物目前在多种恶性肿瘤中进入临床应用，为治疗手段增添了宝贵的选择。这些药物通过调节肿瘤微环境增强全身免疫反应，但可能导致非常规的反应模式，对影像学是治疗效果可靠替代物的概念框架提出挑战。越来越多的证据表明，有效的抗肿瘤反应需要原发性和次级淋巴组织中的全身免疫反应。然而，增强的全身免疫反应会导致健康组织中免疫止血的破坏，引起不良反应。通过组织和液体活检，更好地了解肿瘤和全身免疫反应之间的复杂相互作用。然而，这些方法的适用性受到所涉及过程的生物学、空间和时间异质性的限制。人们对使用生物分子对免疫系统的细胞特异性谱系标志物进行分子成像越来越感兴趣。然而，通过不断完善解释性指南和新出现的证据，人们认识到更广泛使用的 F-FDG PET/CT 在评估反应方面的作用。这些非侵入性方法深入了解全身免疫反应的生物学基础，以最大限度地提高潜在的治疗益处。在这篇综述中，我们旨在概述 F-FDG PET/CT 在监测肿瘤和全身免疫反应中的当前状况。在一篇配套综述中，将讨论可能补充 F-FDG PET/CT 的其他成像探针的作用。
