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Imaging challenges of immunotherapy and targeted therapy in patients with brain metastases: Response, Progression, and Pseudoprogression


Galldiks, Norbert; Kocher, Martin; Ceccon, Garry; Werner, Jan-Michael; Brunn, Anna; Deckert, Martina; Pope, Whitney B; Soffietti, Riccardo; Le Rhun, Emilie; Weller, Michael; Tonn, Jörg C; Fink, Gereon R; Langen, Karl-Josef (2020). Imaging challenges of immunotherapy and targeted therapy in patients with brain metastases: Response, Progression, and Pseudoprogression. Neuro-Oncology, 22(1):17-30.

Abstract

The advent of immunotherapy using immune checkpoint inhibitors (ICI) and targeted therapy (TT) has dramatically improved the prognosis of various cancer types. Following ICI therapy or TT, either alone (especially ICI) or in combination with radiotherapy, however, imaging findings on anatomical contrast-enhanced MRI can be unpredictable, highly variable, and are often difficult to interpret regarding treatment response and outcome. This review aims at summarizing the imaging challenges related to TT and ICI monotherapy as well as combined with radiotherapy in patients with brain metastases, and to give an overview on advanced imaging techniques which potentially overcome some of these imaging challenges. Currently, major evidence suggests that imaging parameters especially derived from amino acid PET, perfusion-/diffusion-weighted MRI, or MR spectroscopy may provide valuable additional information for the differentiation of treatment-induced changes from brain metastases recurrence and the evaluation of treatment response.

Abstract

The advent of immunotherapy using immune checkpoint inhibitors (ICI) and targeted therapy (TT) has dramatically improved the prognosis of various cancer types. Following ICI therapy or TT, either alone (especially ICI) or in combination with radiotherapy, however, imaging findings on anatomical contrast-enhanced MRI can be unpredictable, highly variable, and are often difficult to interpret regarding treatment response and outcome. This review aims at summarizing the imaging challenges related to TT and ICI monotherapy as well as combined with radiotherapy in patients with brain metastases, and to give an overview on advanced imaging techniques which potentially overcome some of these imaging challenges. Currently, major evidence suggests that imaging parameters especially derived from amino acid PET, perfusion-/diffusion-weighted MRI, or MR spectroscopy may provide valuable additional information for the differentiation of treatment-induced changes from brain metastases recurrence and the evaluation of treatment response.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Oncology
Health Sciences > Neurology (clinical)
Life Sciences > Cancer Research
Language:English
Date:11 January 2020
Deposited On:30 Oct 2019 16:06
Last Modified:01 Oct 2020 15:37
Publisher:Oxford University Press
ISSN:1522-8517
OA Status:Green
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/neuonc/noz147
PubMed ID:31437274

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