Pitfalls and Immune-Related Adverse Events
The role of imaging including FDG PET/CT in response assessment, identification, and monitoring of immune-related adverse events (irAEs) is becoming more important given recent accelerated approvals of immunotherapeutic agents for several tumor types that previously had an extremely poor prognosis and lack of therapeutic options. However, the occurrence of irAEs presents challenges for distinction from progressive malignancy. Prompt and accurate imaging diagnosis of irAEs is important given their clinical impact. Due to ever-increasing the number of immunomodulatory agents with different modes of action and their expanding clinical indications, it is vital that clinicians are aware of various and emerging patterns of response and nonmalignant findings that can be associated with their use. It is therefore critical to systematically document the imaging features of irAEs that can be identified during immunotherapy, either as part of routine therapeutic response assessment or to investigate symptoms.
KeywordsImmune-related adverse event Immune checkpoint inhibitor Immunotherapy FDG PET/CT 18F-FDG PET
- 13.Weber JS, Dummer R, de Pril V, Lebbe C, Hodi FS, Investigators MDX. Patterns of onset and resolution of immune-related adverse events of special interest with ipilimumab: detailed safety analysis from a phase 3 trial in patients with advanced melanoma. Cancer. 2013;119(9):1675–82.CrossRefGoogle Scholar
- 20.Sachpekidis C, Larribere L, Pan L, Haberkorn U, Dimitrakopoulou-Strauss A, Hassel JC. Predictive value of early 18F-FDG PET/CT studies for treatment response evaluation to ipilimumab in metastatic melanoma: preliminary results of an ongoing study. Eur J Nucl Med Mol Imaging. 2015;42(3):386–96.CrossRefGoogle Scholar
- 23.Anwar H, Sachpekidis C, Winkler J, Kopp-Schneider A, Haberkorn U, Hassel JC, et al. Absolute number of new lesions on (18)F-FDG PET/CT is more predictive of clinical response than SUV changes in metastatic melanoma patients receiving ipilimumab. Eur J Nucl Med Mol Imaging. 2018;45(3):376–83.CrossRefGoogle Scholar
- 29.Aide N, Hicks RJ, Le Tourneau C, Lheureux S, Fanti S, Lopci E. FDG PET/CT for assessing tumour response to immunotherapy: report on the EANM symposium on immune modulation and recent review of the literature. Eur J Nucl Med Mol Imaging. 2019;46(1):238–50. https://doi.org/10.1007/s00259-018-4171-4.CrossRefPubMedGoogle Scholar