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Review
. 2018 May;10(Suppl 13):S1438-S1446.
doi: 10.21037/jtd.2018.05.130.

The role of radiology in the evaluation of the immunotherapy efficacy

Marco Calandri  1   2 , Federica Solitro  1   2 , Valeria Angelino  1   2 , Federica Moretti  1   2 , Andrea Veltri  1   2
Affiliations
Review

The role of radiology in the evaluation of the immunotherapy efficacy

Marco Calandri et al. J Thorac Dis. 2018 May.

Abstract

In the last years, a great interest has arisen on immunotherapy for the treatment of advanced non-small cell lung cancer (NSCLC). Check-point inhibitor drugs are now considered clinical practice standard in different settings and their use is expected to increase significantly in the near future. As treatment options for lung cancer advance and vary, the different patterns of radiological response increase in number and heterogeneity. To correctly evaluate the radiological findings after and during these treatments is of paramount importance, both in the clinical and sperimental setting. In consideration of their peculiar mechanism, immunotherapies can determine unusual response patterns on imaging, that cannot be correctly evaluated with the traditional response criteria such as World Health Organization (WHO) and Response Evaluation Criteria in Solid Tumours (RECIST). Therefore, during these years, several response criteria [immune-related response criteria (irRC), irRECIST and iRECIST] were proposed and applied in clinical trials on immunotherapies. The aim of this review is to describe the radiological findings after immunotherapy, to critically discuss the different response criteria and the imaging of immune-related adverse events.

Keywords: Lung cancer; adverse events; immunotherapy; radiology; response criteria.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Pseudoprogression and dissociated response. A 68-year-old male patient with history of NSCLC metastatic to lung and liver. (A,B) Axial chest CT images before (A) and after 12 weeks (B) of treatment with nivolumab (an anti-PD-1 monoclonal antibody) showing increase in size of the lesions (arrows) and appearance of new lung nodules (circles: these findings were stable at the subsequent CSI); (C,D) axial CT images of the same patients before (C) and after 12 weeks (D) of treatment showing decrease in size of some liver lesions (arrows) and disappearance of a metastatic lesion (circle). NSCLC, non-small cell lung cancer; CSI, cross sectional imaging.
Figure 2
Figure 2
A 42-year-old female patient with NSCLC in treatment with nivolumab (anti-PD-1 monoclonal antibody). Axial chest CT reveals interlobular septal thickening with small patchy ground-glass opacities in the lower lobes, in a crazy-paving configuration. NSCLC, non-small cell lung cancer.
Figure 3
Figure 3
A 64-year-old male patient with NSCLC in treatment with pembrolizumab (anti-PD-L1 monoclonal antibody). Axial chest CT shows pneumonitis characterized by peri-bronchial confluent parenchymal consolidation in the right lung in association with bilateral ground-glass opacities. NSCLC, non-small cell lung cancer.
Figure 4
Figure 4
A 78-year-old male patient with NSCLC in treatment with nivolumab (anti-PD-1 monoclonal antibody). Axial chest CT demonstrates pneumonitis characterized by fibrosing reticulation, intralobular thickening and traction bronchiectasis, with large areas of honeycombing in the right lung. Pleural effusion is associated. In the left lung there is minimal subpleural interstitial reticulation. NSCLC, non-small cell lung cancer.
See this image and copyright information in PMC

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