Learning objectives
Present immune-mediated adverse effects of immune-check point inhibitors and their radiological features.
Background
Cancer immunotherapy using immune checkpoint inhibitors (ICIs) is a promising new strategy that has demonstrated unprecedent success against advanced cancers.
(1)
Starting with the introduction of ipilimumab for metastatic melanoma,
ICIs are now standard for a for a variety of malignancies,
most notably non-small cell lung carcinoma (e.g.
renal cell carcinoma; urothelial cancer; head and neck squamous cell carcinoma; classical Hodgkin lymphoma).
(1)
It is important for theradiologist to recognize unique adverse events associated with immunotherapy to guide treatment and avoid potential pitfalls.
(2)
Findings and procedure details
Mechanism of action of ICIs
Genetic alterations in cancer antigens can create new antigens,
recognized by the host immune system as “non-self”.
The antitumor response involves a complex interaction between immune cells,
tumor cells and the environment. However,
cancer cells can escape immune recognition and destruction in a variety of ways.
(3)
ICIs are monoclonal antibodies that promote immune system mediated tumor destruction by inhibiting the signaling pathways that suppress anti-tumor T-cell activity,
targeting molecules on the surface of T-cells.
(2) ICIs that are currently...
Conclusion
Cancer immunotherapies are growing as a therapeutic arsenal.
Awareness of radiological features of irAEs can help minimize potential pitfalls and allow for a prompt diagnosis and treatment.
References
Wang,
G.,
Kurra,
V.,
Gainor,
J.,
Sullivan,
R.,
Flaherty,
K.,
Lee,
S.
and Fintelmann,
F.
(2017).
Immune Checkpoint Inhibitor Cancer Therapy: Spectrum of Imaging Findings.RadioGraphics,
37(7),
pp.2132-2144.
Kwak,
J.,
Tirumani,
S.,
Van den Abbeele,
A.,
Koo,
P.
and Jacene,
H.
(2015).
Cancer Immunotherapy: Imaging Assessment of Novel Treatment Response Patterns and Immune-related Adverse Events.RadioGraphics,
35(2),
pp.424-437.
Wang,
G.,
Guo,
L.,
Gainor,
J.
and Fintelmann,
F.
(2017).
Immune Checkpoint Inhibitors in Lung Cancer: Imaging Considerations.American Journal of Roentgenology,
209(3),
pp.567-575.
Sidhu,
P.,
Menzies,
A.,
Long,
G.,...