Cancer Immunotherapy: Imaging Assessment of Novel Treatment Response Patterns and Immune-related Adverse Events

Abstract

Cancer immunotherapy is changing the imaging evaluation of cancer treatment response and treatment-related toxic effects. New emerging patterns of treatment response and treatment-related toxic effects after treatment with immunomodulating agents have been observed. Treatment response after immunomodulatory therapy can be associated with significantly delayed decrease in tumor size, and new or enlarging tumors observed soon after completion of treatment may not reflect disease progression. In addition, activation of the immune system to fight cancer may lead to unwanted autoimmune-mediated toxic effects that could be mistaken for metastatic disease or misdiagnosed as a non-treatment-related process and delay appropriate clinical management. Radiologists must recognize the novel treatment response patterns and the wide range of autoimmune toxic effects, which should not be mistaken for treatment failure or metastatic disease progression.

Pancreatitis Secondary to Anti–Programmed Death Receptor 1 Immunotherapy Diagnosed by FDG PET/CT

“…12,13 Immunotherapy targeting immune checkpoint receptors such as PD-1 and cytotoxic CTLA-4 are associated with a spectrum of inflammatory irAEs including dermatitis, myositis, colitis, uveitis, vasculitis, fasciitis, pneumonia, pancreatitis, hepatitis, arthritis, sarcoid-like adenopathy, and endocrinopathies such as hypophysitis and thyroiditis. [14][15][16] Many of these adverse events may be associated with radiological abnormalities while these patients may present with clinically silent manifestations of these immune-related toxicities, as did our patient. 13 However, the diagnosis of pembrolizumab-induced pancreatitis was further confirmed with laboratory testing demonstrating elevated amylase and lipase levels (107 U/L and 205 U/L, respectively).…”

Unerwünschte Wirkungen der Immuntherapie

“…3; [28]). In der Positronenemissionstomographie(PET)-CT zeigt die immunbedingte Pankreatitis eine gesteigerte Fluordesoxyglukose(FDG)-Aufnahme des Pankreas [20]. Es kann sehr schwierig sein, die Befunde von einer Immunoglobulin-G4-assoziierten Autoimmunpankreatitis zu unterscheiden [20] 4 ein Beispiel mit COP-Muster.…”

“…In der Positronenemissionstomographie(PET)-CT zeigt die immunbedingte Pankreatitis eine gesteigerte Fluordesoxyglukose(FDG)-Aufnahme des Pankreas [20]. Es kann sehr schwierig sein, die Befunde von einer Immunoglobulin-G4-assoziierten Autoimmunpankreatitis zu unterscheiden [20] 4 ein Beispiel mit COP-Muster. Nach dem Auslaufen der Glukokortikoidtherapie kann sich ein "flare" der klinischen und bildgebenden Befunde einer rezidivierenden Pneumonitis zeigen [25].…”

“…Abb. 6; [6,20]). Eine Differenzierung zur rheumatoiden Arthritis kann sehr schwierig sein, antizyklische Citrullinated-peptid-Antikörper und Rheumafaktoren werden jedoch für gewöhnlich nicht gefunden [7].…”

Minimising the impact of errors in the interpretation of CT images for surveillance and evaluation of therapy in cancer

“…More recently, the development of immunotherapy has made pseudo-progression more common 58 ( figure 8). Immunotherapy is a good example of why the oncology radiologist needs to keep abreast of new treatments, which have different complications (immune-related adverse events) and patterns of disease response.…”