Abstract
In the light of the success and the expected growth of its arsenal, immuno-therapy may become the standard neoadjuvant procedure for many cancers in the near future. However, aspects such as the identity, organization and the activation status of the peri- and intra-tumoral immune cells would represent important elements to weigh in the decision for the appropriate treatment. While important progress in non-invasive imaging of immune cells has been made over the last decades, it falls yet short of entering the clinics, let alone becoming a standard procedure. Here, we provide an overview of the different intra-vital imaging approaches in the clinics and in pre-clinical settings and discuss their benefits and drawbacks for assessing the activity of the immune system, globally and on a cellular level. Stimulated by further research, the future is likely to see many technological advances both on signal detection and emission as well as image specificity and resolution to tackle current hurdles. We anticipate that the ability to precisely determine an immune stage of cancer will capture the attention of the oncologist and will create a change in paradigm for cancer therapy.
Highlights
The success of immune checkpoint blockade has initiated a shift in the way we view the relationship between the immune system and cancer
The immune system is no longer seen as the underdog in an unequal duel with cancer but increasingly as a powerful system, potentially capable of fighting and even eradicating tumor cells
While formerly relatively little attention has been paid to the immune system in cancer therapy, it has been recognized to provide precious information regarding tumor staging and to present a serious therapeutic option, in particular when amplified after releasing it from immunecheckpoint blockades
Summary
The success of immune checkpoint blockade has initiated a shift in the way we view the relationship between the immune system and cancer. Non-Invasive Imaging the Immune System in Cancer greatly accelerated so that the capacity to accurately visualize immune cells in vivo becomes reality [1] These technologies have seen applications to observe lymph nodes, especially its architecture and the presence of micro-metastasis, with further clinical applications including pre-operative guidance for selected lymph node resection. Due to their current spatial resolution and acquisition time, CT, PET and MRI are currently insufficient to detect micro-metastasis (< 2 mm), which can be an issue for the accurate preoperative staging of cancers They fail to provides architectural information on the lymph nodes, and CT mostly reveals changes in nodal size. Despite constant progress, the current imaging approaches remain limited to lymph nodes and have not yet reached the cellular level
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