Imaging-guided precision medicine in glioblastoma patients treated with immune checkpoint modulators: research trend and future directions in the field of imaging biomarkers and artificial intelligence

Abstract

Immunotherapies that employ immune checkpoint modulators (ICMs) have emerged as an effective treatment for a variety of solid cancers, as well as a paradigm shift in the treatment of cancers. Despite this breakthrough, the median survival time of glioblastoma patients has remained at about 2 years. Therefore, the safety and anti-cancer efficacy of combination therapies that include ICMs are being actively investigated. Because of the distinct mechanisms of ICMs, which restore the immune system’s anti-tumor capacity, unconventional immune-related phenomena are increasingly being reported in terms of tumor response and progression, as well as adverse events. Indeed, immunotherapy response assessments for neuro-oncology (iRANO) play a central role in guiding cancer patient management and define a “wait and see strategy” for patients treated with ICMs in monotherapy with progressive disease on MRI. This article deciphers emerging research trends to ameliorate four challenges unaddressed by the iRANO criteria: (1) patient selection, (2) identification of immune-related phenomena other than pseudoprogression (i.e., hyperprogression, the abscopal effect, immune-related adverse events), (3) response assessment in combination therapies including ICM, and (4) alternatives to MRI. To this end, our article provides a structured approach for standardized selection and reporting of imaging modalities to enable the use of precision medicine by deciphering the characteristics of the tumor and its immune environment. Emerging preclinical or clinical innovations are also discussed as future directions such as immune-specific targeting and implementation of artificial intelligence algorithms.

Systematic review of radiomic biomarkers for predicting immune checkpoint inhibitor treatment outcomes

“…Significant efforts have been made to standardize definitions of radiomics features, such as the Image Biomarker Standardization Initiative (IBSI), that supports reproducible research and wider generalizability of results [32]. To the authors' knowledge, this is the first systematic review that focuses on radiomic biomarkers for immunotherapy across multiple cancers [18,33,34]. The common element among the cancers and interventions studies is the targeting of one or more specific checkpoint inhibitors expressed by these tumors.…”

Iron Oxide Nanoparticles as Theranostic Agents in Cancer Immunotherapy

“…Ferumoxytol is a colloidal solution of USPIO NPs, composed of an iron oxide core and a semisynthetic carbohydrate coating of polyglucose sorbitol carboxymethyl ether, with a mean hydrodynamic diameter of 30 nm [ 28 ]. Currently used as an alternative contrast agent in patients with impaired renal function, it is being investigated in a clinical trial of glioblastoma treated with immune checkpoint modulators [ 29 ]. Its major advantage compared to other contrast agents is its prolonged intravascular residence time (>12 h), thanks to its size and carbohydrate coating.…”

Lack of Benefit of Extending Temozolomide Treatment in Patients with High Vascular Glioblastoma with Methylated MGMT

“…In this line, imaging markers derived from MRI and combined with the capabilities of artificial intelligence can provide individually specific variations of the Stupp treatment. This would allow better prognosis and facilitate the clinical decision-making for patient treatment in a non-invasive way and without additional cost [35][36][37][38][39].…”