Abstract
The global immuno-oncology pipeline has grown progressively in recent years, leading cancer immunotherapy to become one of the main issues of the healthcare industry. Despite their success in the treatment of several malignancies, immune checkpoint inhibitors (ICIs) perform poorly in others. Again, ICIs action depends on such a multitude of clinico-pathological features, that the attempt to predict responders/long-responders with ad-hoc built immunograms revealed to be quite complex. In this landscape, the role of nuclear medicine might be crucial, with first interesting evidences coming from small case series and pre-clinical studies. Positron-emission tomography (PET) techniques provide functional information having a predictive and/or prognostic value in patients treated with ICIs or adoptive T-cell therapy. Recently, a characterization of the tumor immune microenvironment (TiME) pattern itself has been shown to be feasible through the use of different radioactive tracers or image algorithms, thus adding knowledge about tumor heterogeneity. Finally, nuclear medicine exams permit an early detection of immune-related adverse events (irAEs), with on-going clinical trials investigating their correlation with patients’ outcome. This review depicts the recent advances in molecular imaging both in terms of non-invasive diagnosis of TiME properties and benefit prediction from immunotherapeutic agents.
Highlights
The global immuno-oncology pipeline has grown progressively in recent years, leading cancer immunotherapy to become one of the main issues of the healthcare industry
Variations in metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in FDG-Positron-emission tomography (PET)/computed tomography (CT) scans taken before and after 4 cycles of nivolumab in 20 patients with metastatic NSCLC correlated with objective of low tumor load [79]
41 melanoma treatedrole withinipilimumab, with ipilimumab, functional size of the newin lesions playing patients an important predicting with the functional size of the new lesions playing an important role in predicting the clinical response the clinical response [86]
Summary
Nuclear medicine is a branch of medicine using radionuclides in the diagnosis and treatment of diseases. 2-[18 F]fluoro-2-deoxy-d-glucose (18 F-FDG or FDG) PET/CT has become an established standard nuclear imaging modality in oncology [52] based on the finding that tumor hypoxic cells have increased glucose demand and, FDG uptake and accumulation [53]. Infection and inflammation can lead to false positive findings. Another limitation is that some organs display a higher physiological FDG uptake (i.e., brain, myocardial tissue, brown fat) and are not studied with this modality. For all these reasons, clinical information exchange between oncologists and nuclear medicine specialists is crucial for patients’ care and outcomes [54,55,56]
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