Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.
Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Adv Exp Med Biol. 2021;1342:431-447. doi: 10.1007/978-3-030-79308-1_19.
Immune therapeutics are revolutionizing cancer treatments. In tandem, new and confounding imaging characteristics have appeared that are distinct from those typically seen with conventional cytotoxic therapies. In fact, only 10% of patients on immunotherapy may show tumor shrinkage, typical of positive responses on conventional therapy. Conversely, those on immune therapies may initially demonstrate a delayed response, transient enlargement followed by tumor shrinkage, stable size, or the appearance of new lesions. Response Evaluation Criteria in Solid Tumors (RECIST) or WHO criteria, developed to identify early effects of cytotoxic agents, may not provide a complete evaluation of new emerging treatment response pattern of immunotherapeutic agents. Therefore, new imaging response criteria, such as the immune-related Response Evaluation Criteria in Solid Tumors (irRECIST), immune Response Evaluation Criteria in Solid Tumors (iRECIST), and immune-related Response Criteria (irRC), are proposed. However, FDA approval of emerging therapies including immunotherapies still relies on the current RECIST criteria. In this chapter, we review the traditional and new imaging response criteria for evaluation of solid tumors and briefly touch on some of the more commonly associated immunotherapy-induced adverse events.
免疫疗法正在彻底改变癌症治疗方法。与此同时，新的、令人困惑的成像特征出现了，与传统细胞毒性疗法通常所见的特征明显不同。事实上，只有 10%的免疫治疗患者可能出现肿瘤缩小，这是传统治疗中阳性反应的典型表现。相反，那些接受免疫治疗的患者最初可能表现出延迟反应，短暂增大后肿瘤缩小，肿瘤大小稳定，或出现新的病变。为了识别细胞毒性药物的早期效果而制定的实体瘤反应评估标准（RECIST）或世界卫生组织（WHO）标准，可能无法对新出现的免疫治疗药物的治疗反应模式进行全面评估。因此，提出了新的成像反应标准，如免疫相关实体瘤反应评估标准（irRECIST）、实体瘤免疫反应评估标准（iRECIST）和免疫相关反应标准（irRC）。然而，美国食品和药物管理局（FDA）对包括免疫疗法在内的新兴疗法的批准仍然依赖于目前的 RECIST 标准。在本章中，我们回顾了评估实体瘤的传统和新的成像反应标准，并简要介绍了一些更常见的与免疫治疗相关的不良反应。
