Therapiekontrolle bei Immuntherapien mittels PET/CT

Zusammenfassung

In der Therapiekontrolle bei Immuntherapien werden neben klinischen Einschätzungen auch bildgebende Verfahren eingesetzt. Hier gibt es einige Herausforderungen, die bei der Beurteilung beachtet werden müssen. Insbesondere der Pseudoprogress, Hyperprogress, ein heterogenes Therapieansprechen sowie unerwünschte Arzneimittelwirkungen können die Beurteilung des Therapieansprechens erschweren. Im Vergleich zur Computertomografie (CT) oder Magnetresonanztomografie (MRT) können Positronenemissionstomografie (PET)/Computertomografie (CT)-Untersuchungen zusätzliche Informationen liefern und bei der besseren Einordnung von Veränderungen helfen. Sowohl für die Beurteilung mittels CT und MRT als auch mittels PET/CT wurden bereits mehrere Klassifikationssysteme entwickelt, wobei sich für die Therapiebeurteilung mittels PET/CT noch keine Klassifikation als Standard im klinischen Alltag etabliert hat.

Abstract

In addition to clinical assessments, imaging techniques are used for therapy control in immunotherapies. Challenges that can complicate the assessment of therapy response and need to be considered in the assessment include pseudoprogression, hyperprogression, heterogeneous therapy response and adverse drug reactions. Compared to computed tomography (CT) or magnetic resonance imaging (MRI), positron emission tomography (PET)/computed tomography (CT) scans can provide additional information and help to assess changes. Several classification systems have been developed for both CT and MRI as well as PET/CT assessments, although no classification system has been established as a standard for PET/CT therapy assessment in clinical practice.

Schlüsselwörter

Immuntherapien - PET/CT - Therapiekontrolle - Pseudoprogress - Unerwünschte Arzneimittelwirkungen

Keywords

PET/CT - immunotherapy - therapy control - pseudoprogression - adverse drug reactions

• Literatur

• 1 Arndt V, Dahm S, Kraywinkel K. Krebsprävalenz in Deutschland 2017: Anzahl der Cancer Survivors basierend auf Daten bevölkerungsbezogener Krebsregister. Onkologe 2021; 27: 717-723
• 2 Royal RE, Levy C, Turner K. et al. Phase 2 trial of single agent Ipilimumab (anti-CTLA-4) for locally advanced or metastatic pancreatic adenocarcinoma. J Immunother 2010; 33: 828-833
• 3 Larimer BM, Wehrenberg-Klee E, Dubois F. et al. Granzyme B PET Imaging as a Predictive Biomarker of Immunotherapy Response. Cancer Res 2017; 77: 2318-2327
• 4 Evangelista L, Sepulcri M, Pasello G. PET/CT and the Response to Immunotherapy in Lung Cancer. Curr Radiopharm 2020; 13: 177-184
• 5 Waldman AD, Fritz JM, Lenardo MJ. A guide to cancer immunotherapy: from T cell basic science to clinical practice. Nat Rev Immunol 2020; 20: 651-668
• 6 Syn NL, Teng MWL, Mok TSK. et al. De-novo and acquired resistance to immune checkpoint targeting. Lancet Oncol 2017; 18: e731-e741
• 7 Unterrainer M, Ruzicka M, Fabritius MP. et al. PET/CT imaging for tumour response assessment to immunotherapy: current status and future directions. Eur Radiol Exp 2020; 4: 63
• 8 Aide N, Hicks RJ, Le Tourneau C. et al. FDG PET/CT for assessing tumour response to immunotherapy: Report on the EANM symposium on immune modulation and recent review of the literature. Eur J Nucl Med Mol Imaging 2019; 46: 238-250
• 9 Esfahani K, Roudaia L, Buhlaiga N. et al. A review of cancer immunotherapy: from the past, to the present, to the future. Curr Oncol 2020; 27: S87-S97
• 10 Wang Z, Wu Z, Liu Y. et al. New development in CAR-T cell therapy. J Hematol Oncol 2017; 10: 53
• 11 Seymour L, Bogaerts J, Perrone A. et al. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics. Lancet Oncol 2017; 18: e143-e152
• 12 Baylet A, Laclaverie M, Marchand L. et al. Immunotherapies in cutaneous pathologies: an overview. Drug Discov Today 2021; 26: 248-255
• 13 Wolchok JD, Hoos A, O’Day S. et al. Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria. Clin Cancer Res 2009; 15: 7412-7420
• 14 Frelaut M, Le Tourneau C, Borcoman E. Hyperprogression under Immunotherapy. Int J Mol Sci 2019; 20: 2674
• 15 Greaves M, Maley CC. Clonal evolution in cancer. Nature 2012; 481: 306-313
• 16 Eisenhauer EA, Therasse P, Bogaerts J. et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247
• 17 Parihar AS, Dehdashti F, Wahl RL. FDG PET/CT-based Response Assessment in Malignancies. Radiographics 2023; 43: e220122
• 18 Young H, Baum R, Cremerius U. et al. Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. Eur J Cancer 1999; 35: 1773-1782
• 19 Wahl RL, Jacene H, Kasamon Y. et al. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med 2009; 50 (Suppl. 01) 122S-150S
• 20 Cho SY, Lipson EJ, Im H-J. et al. Prediction of Response to Immune Checkpoint Inhibitor Therapy Using Early-Time-Point 18F-FDG PET/CT Imaging in Patients with Advanced Melanoma. J Nucl Med 2017; 58: 1421-1428
• 21 Anwar H, Vogl TJ, Abougabal MA. et al. The value of different 18F-FDG PET/CT baseline parameters in risk stratification of stage I surgical NSCLC patients. Ann Nucl Med 2018; 32: 687-694
• 22 Cheson BD, Fisher RI, Barrington SF. et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 2014; 32: 3059-3068
• 23 Cheson BD, Ansell S, Schwartz L. et al. Refinement of the Lugano Classification lymphoma response criteria in the era of immunomodulatory therapy. Blood 2016; 128: 2489-2496
• 24 Younes A, Hilden P, Coiffier B. et al. International Working Group consensus response evaluation criteria in lymphoma (RECIL 2017). Ann Oncol 2017; 28: 1436-1447