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Review
. 2023 Jan 13;13(2):302.
doi: 10.3390/diagnostics13020302.

Immunotherapy Assessment: A New Paradigm for Radiologists

Vincenza Granata  1 , Roberta Fusco  2   3 , Sergio Venanzio Setola  1 , Igino Simonetti  1 , Carmine Picone  1 , Ester Simeone  4 , Lucia Festino  4 , Vito Vanella  4 , Maria Grazia Vitale  4 , Agnese Montanino  5 , Alessandro Morabito  5 , Francesco Izzo  6 , Paolo Antonio Ascierto  3 , Antonella Petrillo  1
Affiliations
Review

Immunotherapy Assessment: A New Paradigm for Radiologists

Vincenza Granata et al. Diagnostics (Basel). .

Abstract

Immunotherapy denotes an exemplar change in an oncological setting. Despite the effective application of these treatments across a broad range of tumors, only a minority of patients have beneficial effects. The efficacy of immunotherapy is affected by several factors, including human immunity, which is strongly correlated to genetic features, such as intra-tumor heterogeneity. Classic imaging assessment, based on computed tomography (CT) or magnetic resonance imaging (MRI), which is useful for conventional treatments, has a limited role in immunotherapy. The reason is due to different patterns of response and/or progression during this kind of treatment which differs from those seen during other treatments, such as the possibility to assess the wide spectrum of immunotherapy-correlated toxic effects (ir-AEs) as soon as possible. In addition, considering the unusual response patterns, the limits of conventional response criteria and the necessity of using related immune-response criteria are clear. Radiomics analysis is a recent field of great interest in a radiological setting and recently it has grown the idea that we could identify patients who will be fit for this treatment or who will develop ir-AEs.

Keywords: Recist 1.1; i-Recist; immuno-related adverse events; immunotherapy; radiological response assessment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Complete response pattern in a mesothelioma patient treated with immunotherapy. CT scan assessment in pre-treatment phase (A) of lesion (arrow), at 3 months (B), and after 6 months (C).
Figure 2
Figure 2
Partial response pattern in non small lung cancer (NSLC) treated with immunotherapy (arrows). CT scan assessment in pre-treatment phase (A,D), at 3 months (B,E), and after 6 months (C,F).
Figure 3
Figure 3
Pseudoprogression of brain metastasis (arrows) in an NSLC patient treated with immunotherapy. CT evaluation (A) in pre-treatment phase, after 1 month (B), and after 12 weeks of the first CT evaluation (C).
Figure 4
Figure 4
Iperprogression in an NSLC (arrows) patient treated with immunotherapy. CT assessment in pre-treatment phase (A–C) and after 3 months (D–F).
Figure 5
Figure 5
The same patient in Figure 4 (A). New lesions (arrows) in ileo-psoas muscle (B) due to iperprogression during immunotherapy.
Figure 6
Figure 6
Dissociated responses in a melanoma patient during immunotherapy. CT assessment in pre-treatment phase (A) and at 3 months (B) follow-up: black arrows show the regression of the lesion while white arrows show the increase in lesion dimensions.
Figure 7
Figure 7
NSLC (black arrows) patient treated with immunotherapy. CT assessment in pre-treatment phase (A). During follow-up, in (B), appearance of ir-Pneumonitis (white arrow), with disease regression after corticosteroid treatment (C).
See this image and copyright information in PMC

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