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Drug Toxicity, Approach to Cancer as a Systemic Disease, and Imaging Modality-Specific Considerations

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Therapy Response Imaging in Oncology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

In addition to the limitations and pitfalls of tumor response criteria and strategies, there are practical pitfalls for therapy response imaging in cancer patients that should be recognized for accurate characterization of tumor response and progression. Drug toxicity in major organs can be noted on imaging with an appearance of unique radiologic characteristics, and should be distinguished from tumor progression. Approaching cancer as a systemic disease is another important concept, because treating physicians need to know the systemic tumor burden changes to make treatment decisions, rather than the changes in individual body parts. Finally, the choice of imaging modality is a key to maximize the contributions of imaging for therapy response assessment, and the strengths and weaknesses in each modality in specific clinical settings need to be acknowledged.

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References

  • Berthod G, Lazor R, Letovanec I et al (2012) Pulmonary sarcoid-like granulomatosis induced by ipilimumab. J Clin Oncol 30:e156–e159

    Article  PubMed  Google Scholar 

  • Bronstein Y, Ng CS, Hwu P, Hwu WJ (2011) Radiologic manifestations of immune-related adverse events in patients with metastatic melanoma undergoing anti-CTLA-4 antibody therapy. AJR Am J Roentgenol 197:W992–W1000

    Article  PubMed  Google Scholar 

  • Burotto M, Manasanch EE, Wilkerson J, Fojo T (2015) Gefitinib and erlotinib in metastatic non-small cell lung cancer: a meta-analysis of toxicity and efficacy of randomized clinical trials. Oncologist 20:400–410

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dabydeen DA, Jagannathan JP, Ramaiya N et al (2012) Pneumonitis associated with mTOR inhibitors therapy in patients with metastatic renal cell carcinoma: incidence, radiographic findings and correlation with clinical outcome. Eur J Cancer 48:1519–1524

    Article  CAS  PubMed  Google Scholar 

  • Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247

    Article  CAS  PubMed  Google Scholar 

  • Freeman-Keller M, Kim Y, Cronin H, Richards A, Gibney G, Weber JS (2016) Nivolumab in resected and unresectable metastatic melanoma: characteristics of immune-related adverse events and association with outcomes. Clin Cancer Res 22:886–894

    Article  CAS  PubMed  Google Scholar 

  • Gemma A, Kudoh S, Ando M et al (2014) Final safety and efficacy of erlotinib in the phase 4 POLARSTAR surveillance study of 10 708 Japanese patients with non-small-cell lung cancer. Cancer Sci 105:1584–1590

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Haratani K, Hayashi H, Chiba Y et al (2018) Association of immune-related adverse events with nivolumab efficacy in non-small-cell lung cancer. JAMA Oncol 4:374–378

    Article  PubMed  Google Scholar 

  • Hillengass J, Ayyaz S, Kilk K et al (2012) Changes in magnetic resonance imaging before and after autologous stem cell transplantation correlate with response and survival in multiple myeloma. Haematologica 97:1757–1760

    Article  PubMed  PubMed Central  Google Scholar 

  • Holmes D (2011) PI3K pathway inhibitors approach junction. Nat Rev Drug Discov 10:563–564

    Article  CAS  PubMed  Google Scholar 

  • Kudoh S, Kato H, Nishiwaki Y et al (2008) Interstitial lung disease in Japanese patients with lung cancer: a cohort and nested case-control study. Am J Respir Crit Care Med 177:1348–1357

    Article  PubMed  Google Scholar 

  • Lee H, Lee HY, Sun JM et al (2018) Transient asymptomatic pulmonary opacities during osimertinib treatment and its clinical implication. J Thorac Oncol 13(8):1106–1112

    Article  PubMed  Google Scholar 

  • Maroto JP, Hudes G, Dutcher JP et al (2011) Drug-related pneumonitis in patients with advanced renal cell carcinoma treated with temsirolimus. J Clin Oncol 29:1750–1756

    Article  CAS  PubMed  Google Scholar 

  • Messiou C, Kaiser M (2015) Whole body diffusion weighted MRI—a new view of myeloma. Br J Haematol 171:29–37

    Article  PubMed  PubMed Central  Google Scholar 

  • Michot JM, Bigenwald C, Champiat S et al (2016) Immune-related adverse events with immune checkpoint blockade: a comprehensive review. Eur J Cancer 54:139–148

    Article  CAS  PubMed  Google Scholar 

  • Morone M, Bali MA, Tunariu N et al (2017) Whole-body MRI: current applications in oncology. AJR Am J Roentgenol 209:W336–w349

    Article  PubMed  Google Scholar 

  • Nishino M, Jagannathan JP, Ramaiya NH, Van den Abbeele AD (2010a) Revised RECIST guideline version 1.1: what oncologists want to know and what radiologists need to know. AJR Am J Roentgenol 195:281–289

    Article  PubMed  Google Scholar 

  • Nishino M, Jackman DM, Hatabu H et al (2010b) New Response Evaluation Criteria in Solid Tumors (RECIST) guidelines for advanced non-small cell lung cancer: comparison with original RECIST and impact on assessment of tumor response to targeted therapy. AJR Am J Roentgenol 195:W221–W228

    Article  PubMed  PubMed Central  Google Scholar 

  • Nishino M, Hatabu H, Johnson BE, McLoud TC (2014) State of the art: response assessment in lung cancer in the era of genomic medicine. Radiology 271:6–27

    Article  PubMed  Google Scholar 

  • Nishino M, Sholl LM, Hodi FS, Hatabu H, Ramaiya NH (2015a) Anti-PD-1-related pneumonitis during cancer immunotherapy. N Engl J Med 373:288–290

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nishino M, Boswell EN, Hatabu H, Ghobrial IM, Ramaiya NH (2015b) Drug-related pneumonitis during mammalian target of rapamycin inhibitor therapy: radiographic pattern-based approach in Waldenstrom macroglobulinemia as a paradigm. Oncologist 20:1077–1083

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nishino M, Chambers ES, Chong CR et al (2016a) Anti-PD-1 inhibitor-related pneumonitis in non-small cell lung cancer. Cancer Immunol Res 4:289–293

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nishino M, Giobbie-Hurder A, Hatabu H, Ramaiya NH, Hodi FS (2016b) Incidence of programmed cell death 1 inhibitor-related pneumonitis in patients with advanced cancer: a systematic review and meta-analysis. JAMA Oncol 2(12):1607–1616

    Article  PubMed  Google Scholar 

  • Nishino M, Ramaiya NH, Awad MM et al (2016c) PD-1 inhibitor-related pneumonitis in advanced cancer patients: radiographic patterns and clinical course. Clin Cancer Res 22:6051–6060

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nishino M, Brais LK, Brooks NV, Hatabu H, Kulke MH, Ramaiya NH (2016d) Drug-related pneumonitis during mammalian target of rapamycin inhibitor therapy in patients with neuroendocrine tumors: a radiographic pattern-based approach. Eur J Cancer 53:163–170

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nishino M, Hatabu H, Sholl LM, Ramaiya NH (2017a) Thoracic complications of precision cancer therapies: a practical guide for radiologists in the new era of cancer care. Radiographics 37:1371–1387

    Article  PubMed  Google Scholar 

  • Nishino M, Hatabu H, Hodi FS, Ramaiya NH (2017) Drug-related pneumonitis in the era of precision cancer therapy. JCO Precis Oncol – published online May 26. https://doi.org/10.1200/PO.17.00026

  • Nishino M, Sholl LM, Awad MM, Hatabu H, Armand P, Hodi FS (2018) Sarcoid-like granulomatosis of the lung related to immune-checkpoint inhibitors: distinct clinical and imaging features of a unique immune-related adverse event. Cancer Immunol Res 6(6):630–635

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nishino M, Hatabu H, Hodi FS (2019) Imaging of cancer immunotherapy: current approaches and future directions. Radiology 290:9–22

    Article  PubMed  Google Scholar 

  • Noonan SA, Sachs PB, Camidge DR (2016) Transient asymptomatic pulmonary opacities occurring during osimertinib treatment. J Thorac Oncol 11:2253–2258

    Article  PubMed  PubMed Central  Google Scholar 

  • Ren Y, Jiao Y, Ge W et al (2018) Dual-energy computed tomography-based iodine quantitation for response evaluation of lung cancers to chemoradiotherapy/radiotherapy: a comparison with fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography-based positron emission tomography/computed tomography response evaluation criterion in solid tumors. J Comput Assist Tomogr 42:614–622

    PubMed  Google Scholar 

  • Sato K, Akamatsu H, Murakami E et al (2018) Correlation between immune-related adverse events and efficacy in non-small cell lung cancer treated with nivolumab. Lung Cancer 115:71–74

    Article  PubMed  Google Scholar 

  • Soria JC, Shepherd FA, Douillard JY et al (2009) Efficacy of everolimus (RAD001) in patients with advanced NSCLC previously treated with chemotherapy alone or with chemotherapy and EGFR inhibitors. Ann Oncol 20:1674–1681

    Article  PubMed  Google Scholar 

  • Soria JC, Ohe Y, Vansteenkiste J et al (2018) Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N Engl J Med 378:113–125

    Article  CAS  PubMed  Google Scholar 

  • Suh CH, Park HS, Kim KW, Pyo J, Hatabu H, Nishino M (2018) Pneumonitis in advanced non-small-cell lung cancer patients treated with EGFR tyrosine kinase inhibitor: meta-analysis of 153 cohorts with 15,713 patients: meta-analysis of incidence and risk factors of EGFR-TKI pneumonitis in NSCLC. Lung Cancer 123:60–69

    Article  PubMed  Google Scholar 

  • Tirumani SH, Shinagare AB, Jagannathan JP, Krajewski KM, Ramaiya NH (2014) Multidetector-row CT of tumour-bowel fistula: experience at a tertiary cancer centre. Clin Radiol 69:e100–e107

    Article  CAS  PubMed  Google Scholar 

  • Tirumani SH, Ramaiya NH, Keraliya A et al (2015a) Radiographic profiling of immune-related adverse events in advanced melanoma patients treated with ipilimumab. Cancer Immunol Res 3:1185–1192

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tirumani SH, Fairchild A, Krajewski KM et al (2015b) Anti-VEGF molecular targeted therapies in common solid malignancies: comprehensive update for radiologists. Radiographics 35:455–474

    Article  PubMed  Google Scholar 

  • Toi Y, Sugawara S, Kawashima Y et al (2018) Association of immune-related adverse events with clinical benefit in patients with advanced non-small-cell lung cancer treated with nivolumab. Oncologist 23(11):1358–1365

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Uhrig M, Sedlmair M, Schlemmer HP, Hassel JC, Ganten M (2013) Monitoring targeted therapy using dual-energy CT: semi-automatic RECIST plus supplementary functional information by quantifying iodine uptake of melanoma metastases. Cancer Imaging 13:306–313

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Van den Abbeele AD, Krajewski KM, Tirumani SH et al (2016) Cancer imaging at the crossroads of precision medicine: perspective from an academic imaging department in a Comprehensive Cancer Center. J Am Coll Radiol 13:365–371

    Article  PubMed  Google Scholar 

  • Viswanathan C, Truong MT, Sagebiel TL et al (2014) Abdominal and pelvic complications of nonoperative oncologic therapy. Radiographics 34:941–961

    Article  PubMed  Google Scholar 

  • Weber JS, Hodi FS, Wolchok JD et al (2017) Safety profile of nivolumab monotherapy: a pooled analysis of patients with advanced melanoma. J Clin Oncol 35:785–792

    Article  CAS  PubMed  Google Scholar 

  • Zajicek G (1978) Cancer as a systemic disease. Med Hypotheses 4:193–207

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Mizuki Nishino .

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Park, H., Nishino, M. (2020). Drug Toxicity, Approach to Cancer as a Systemic Disease, and Imaging Modality-Specific Considerations. In: Nishino, M. (eds) Therapy Response Imaging in Oncology. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-030-31171-1_3

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  • DOI: https://doi.org/10.1007/978-3-030-31171-1_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-31170-4

  • Online ISBN: 978-3-030-31171-1

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