Learning objectives
To highlight the most relevant immune-related adverse events (irAEs) for which imaging has an important role for identification and management.
To describe the most important radiological signs of irAEs and related differential diagnoses.
To provide general guidance to the management of most significant irAEs.
Background
In 2011 the U.S.
Food and Drug Administration approved the first immune checkpoint inhibitor (ICI)for cancer care.
Subsequently there was a rapid expansion ofICIsin clinical use to such an extent that these agents are now standard therapies for several malignancies.
Since immunotherapy with ICIs has only recently been introduced in clinical practice,
radiologists are not familiar with the radiological signs of irAEs.
Mechanism of action
The tumor microenvironment can overexpress molecules capable of inhibiting theT-cell–mediated immune response.
Central to this process are three molecules:
cytotoxic...
Findings and procedure details
The following isan exhaustive overview of clinical and radiological signs ofthemost significant irAEs,
according to the existing literature on clinical andimagingfindings of irAEs induced by the currently approved ICIs,
administered both as monotherapy or in combination.
Furthermore,
we present examples of irAEs and provide a description of their incidence rate,
clinical,
laboratory,
anatomical and functional imaging findings,
relevant differential diagnoses,
and recommended management.
Enterocolitis
Besides dermatologic toxicity,
it is the most frequent irAEs.
More frequent for anti–CTLA-4.
Median time to onset: 5-10 weeks after start...
Conclusion
Early identification and appropriate treatment of irAEs can improve patient outcome.
Therefore,
in the emerging panorama of irAEs,
radiologists are becoming increasingly involved and are key contributors of cancer patient care.
Personal information
The study was carried out at the Candiolo Cancer Institure (Torino).
Since November 5,
2018 Vanina Vani(mail) moved fromthe Candiolo Cancer Institute to the University of Pisa.
References
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Imaging...