Abstract
PurposeThe advent of immune checkpoint inhibitors (ICIs) has revolutionized the treatment of advanced NSCLC, leading to a string of approvals in recent years. Herein, a narrative review on the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in the ever-evolving treatment landscape of advanced NSCLC is presented.MethodsThis comprehensive review will begin with an introduction into current treatment paradigms incorporating ICIs; the evolution of CT-based criteria; moving onto novel phenomena observed with ICIs and the current state of hybrid imaging for diagnosis, treatment planning, evaluation of treatment efficacy and toxicity in advanced NSCLC, also taking into consideration its limitations and future directions.ConclusionsThe advent of ICIs marks the dawn of a new era bringing forth new challenges particularly vis-à-vis treatment response assessment and observation of novel phenomena accompanied by novel systemic side effects. While FDG PET/CT is widely adopted for tumor volume delineation in locally advanced disease, response assessment to immunotherapy based on current criteria is of high clinical value but has its inherent limitations. In recent years, modifications of established (PET)/CT criteria have been proposed to provide more refined approaches towards response evaluation. Not only a comprehensive inclusion of PET-based response criteria in prospective randomized controlled trials, but also a general harmonization within the variety of PET-based response criteria is pertinent to strengthen clinical implementation and widespread use of hybrid imaging for response assessment in NSCLC.
Highlights
Intrinsic genomic instability in non-small cell lung cancer (NSCLC) has facilitated resistance to cytotoxic or targetedThis article is part of the Topical Collection on Oncology - Chest.Eur J Nucl Med Mol Imaging (2021) 48:3975–3989Immune checkpoints are inhibitory pathways that are pertinent to self-tolerance
As a means of counterpoise, immune checkpoint inhibitors (ICIs) which act by inhibiting these specific inhibitory immune checkpoints were developed
The assessment of programmed cell death ligand 1 (PD-L1) expression—despite its inherent limitations—is widely regarded as the best available predictive biological biomarker and the search for more robust biomarkers remains an area of intensive research [4]
Summary
This comprehensive review will begin with an introduction into current treatment paradigms incorporating ICIs; the evolution of CT-based criteria; moving onto novel phenomena observed with ICIs and the current state of hybrid imaging for diagnosis, treatment planning, evaluation of treatment efficacy and toxicity in advanced NSCLC, taking into consideration its limitations and future directions
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