Evolution of Radiological Treatment Response Assessments for Cancer Immunotherapy: From iRECIST to Radiomics and Artificial Intelligence

Abstract

Immunotherapy has revolutionized and opened a new paradigm for cancer treatment. In the era of immunotherapy and molecular targeted therapy, precision medicine has gained emphasis, and an early response assessment is a key element of this approach. Treatment response assessment for immunotherapy is challenging for radiologists because of the rapid development of immunotherapeutic agents, from immune checkpoint inhibitors to chimeric antigen receptor-T cells, with which many radiologists may not be familiar, and the atypical responses to therapy, such as pseudoprogression and hyperprogression. Therefore, new response assessment methods such as immune response assessment, functional/molecular imaging biomarkers, and artificial intelligence (including radiomics and machine learning approaches) have been developed and investigated. Radiologists should be aware of recent trends in immunotherapy development and new response assessment methods.

Radiological assessment of immunotherapy effects and immune checkpoint‐related pneumonitis for lung cancer

“…Previous studies have established an approximately 6% incidence of pseudoprogression, with different types of tumour and immunotherapy 91,92 . A short‐term follow‐up in 4–6 weeks could generally confirm whether it's pseudoprogression or true in these patients 93 …”

“… 91 , 92 A short‐term follow‐up in 4–6 weeks could generally confirm whether it's pseudoprogression or true in these patients. 93 …”

Immune checkpoint blockade for locally advanced or recurrent/metastatic cervical cancer: An update on clinical data

“…One study used deep learning artificial intelligence-based algorithms to analyze the CheckMate-038 trial and found that it could predict the expression of tumor-specific T-cell receptors in melanoma patients receiving immunotherapy (118). Most of these new technologies are in the exploratory stage and may be used to test drug efficacy, predict adverse effects (119)(120)(121), screen for potential biomarkers, and aid in drug development.…”

New Oncologic Imaging Section in the Korean Journal of Radiology

“…Moreover, modern oncologic imaging often employs a multimodal approach, combining conventional radiologic imaging with nuclear medicine techniques. To accommodate these evolving practices, KJR has recently published a few articles in a distinct subject category of Oncologic Imaging, even though a formal section dedicated to this topic has not yet been established [ 2 ].…”