Learning objectives
Outline the main targeted therapies and their mechanisms of action.
Recognize the most common adverse effects (AE) associated with targeted antitumor therapies.
Background
Currently, there are more than 85 target therapies against up to 27 types of cancer. These therapies attack signaling pathways important for proliferation and survival of cancer cells or activate immune checkpoints and thus stimulate antitumor immune response.
Adverse effects can be expected in a frequency as high as 90%. A deep understanding of its molecular basis allows us to explain their radiological findings in order to identify them promptly and differentiate them from other relevant entities that require specific treatments, including tumor progression.
Radiologists...
Findings and procedure details
There are two main types of treatment, tyrosine kinase inhibitors (TKI) that are named with the IB suffix (i.e. erlotinib and imatinib) and monoclonal antibodies (MAB) that end with the AB suffix (i.e. bevacizumab and trastuzumab).
TKI have higher toxicity than monoclonal antibodies, given the ubiquitous location of tyrosine kinases in the body.
There have been 10 mechanisms described that allow cancer to survive (Fig1), each of them having a potential role as a therapeutic target. We will review the 3 main mechanisms, considering they...
Conclusion
Knowing the molecular basis of targeted therapy allows us to understand their adverse effects and imaging manifestations.
It is important to recognize imaging findings of targeted therapies toxicity due to resemblance to other entities and their impact on patient management.
Symptoms and imaging findings are nonspecific and accurate imaging interpretation depends on clinical information and multidisciplinary communication.
Personal information and conflict of interest
E. A. Rincon:
Nothing to disclose
M. Renjifo:
Nothing to disclose
H. J. Delgado Argote:
Nothing to disclose
E. J. Ortiz Hormaza:
Nothing to disclose
References
Thomas R, Howard SA, Laferriere SL, Braschi-Amirfarzan M. A review of the mechanisms and clinical implications of precision cancer therapy-related toxicity: A primer for the radiologist. Am J Roentgenol. 2020;215(3):770–80.
García-Figueiras R, Baleato-González S, Luna A, Muñoz-Iglesias J, Oleaga L, Casas JAV, et al. Assessing immunotherapy with functional and molecular imaging and radiomics. Radiographics. 2020;40(7):1987–2010.
Shivaji U, Jeffery L, Gui X, Smith SCL, Ahmad OF, Akbar A, et al. Immune checkpoint inhibitor-associated gastrointestinal and hepatic adverse events and their management. Therap Adv Gastroenterol. 2019;12:1–15.
Alessandrino...