Liao Xuhe, Liu Meng, Wang Rongfu, Zhang Jianhua
Department of Nuclear Medicine, Peking University First Hospital, Beijing, China.
Front Genet. 2022 Feb 4;12:810011. doi: 10.3389/fgene.2021.810011. eCollection 2021.
The immune checkpoint inhibitors (ICIs), by targeting cytotoxic-T-lymphocyte-associated protein 4, programmed cell death 1 (PD-1), or PD-ligand 1, have dramatically changed the natural history of several cancers, including non-small cell lung cancer (NSCLC). There are unusual response manifestations (such as pseudo-progression, hyper-progression, and immune-related adverse events) observed in patients with ICIs because of the unique mechanisms of these agents. These specific situations challenge response and prognostic assessment to ICIs challenging. This review demonstrates how F-FDG PET/CT can help identify these unusual response patterns in a non-invasive and effective way. Then, a series of semi-quantitative parameters derived from F-FDG PET/CT are introduced. These indexes have been recognized as the non-invasive biomarkers to predicting the efficacy of ICIs and survival of NSCLC patients according to the latest clinical studies. Moreover, the current situation regarding the functional criteria based on F-FDG PET/CT for immunotherapeutic response assessment is presented and analyzed. Although the criteria based on F-FDG PET/CT proposed some resolutions to overcome limitations of morphologic criteria in the assessment of tumor response to ICIs, further researches should be performed to validate and improve these assessing systems. Then, the last part in this review displays the present status and a perspective of novel specific PET probes targeting key molecules relevant to immunotherapy in prediction and response assessment.
免疫检查点抑制剂(ICI)通过靶向细胞毒性T淋巴细胞相关蛋白4、程序性细胞死亡蛋白1(PD-1)或PD-配体1,显著改变了包括非小细胞肺癌(NSCLC)在内的多种癌症的自然病程。由于这些药物的独特机制,接受ICI治疗的患者会出现一些不寻常的反应表现(如假性进展、超进展和免疫相关不良事件)。这些特殊情况对ICI的反应和预后评估提出了挑战。本综述展示了F-FDG PET/CT如何以无创且有效的方式帮助识别这些不寻常的反应模式。然后,介绍了一系列从F-FDG PET/CT得出的半定量参数。根据最新临床研究,这些指标已被公认为预测ICI疗效和NSCLC患者生存的无创生物标志物。此外,还介绍并分析了基于F-FDG PET/CT的免疫治疗反应评估功能标准的现状。尽管基于F-FDG PET/CT的标准提出了一些解决方案,以克服形态学标准在评估肿瘤对ICI反应方面的局限性,但仍需进一步研究来验证和改进这些评估系统。最后,本综述的最后一部分展示了针对与免疫治疗相关的关键分子的新型特异性PET探针在预测和反应评估中的现状及前景。