Cancer Imaging in the Era of Immunotherapy: Challenges and Opportunities

The evolution of cancer treatment is experiencing the emergence of immune checkpoint blockade as a promising strategy with distinct response patterns and challenges. Medical imaging plays a pivotal role in evaluating responses to immunotherapy and monitoring immune-related adverse events, challenging traditional size-based tumor assessment criteria like RECIST 1.1 due to the dynamic nature of immunotherapies. This underscores the necessity for innovative imaging techniques. Existing guidelines may not completely encapsulate the distinct dynamics of immunotherapy responses, prompting the need for modifications of existing criteria or introduction of novel criteria such as iRECIST. These criteria when combined with functional imaging using PET/CT, further improve tumor detection, characterization, and response assessment to immunotherapies.

When focusing on the landscape of current response assessment criteria for immunotherapy there are unique issues encountered such as:

• Pseudoprogression: Immunotherapy may initially cause tumor enlargement, mimicking progression, before stabilizing or shrinking, leading to clinical benefit.
• Dissociated Response: While some lesions may progress, others can stabilize or shrink, indicating a complex tumor microenvironment response.
• Abscopal Response: Local treatment triggering a systemic antitumor response, demonstrating the interconnected nature of immune responses.
• Hyperprogression: A rare but severe acceleration of tumor growth kinetics with immunotherapy, emphasizing the importance of early detection and management.

Multimodal data integration that combines imaging with omics data offers a dynamic interrogation of tumor dynamics, enhancing the understanding of tumor biology and treatment outcomes. Also, Artificial Intelligence and novel imaging modalities such as immuno-PET offer promising avenues for more precise imaging analysis, offering potential biomarkers for prognosis, treatment response, and adverse event prediction in immunotherapy.

Dr. Manish Sharma, Chief Scientific Officer at Imaging Endpoints explains, “While RECIST 1.1 has its value for pivotal trials, customizing it with criteria modifications or clarifications and advanced modalities is crucial for optimizing trial outcomes.”

Imaging Endpoints stands at the forefront of collaborating with scientists, oncologists, radiologists, and regulatory experts to refine imaging criteria and incorporate cutting-edge modalities in immunotherapy clinical trials. With a proven track record of enhancing trial success rates through meticulous study design, our team of experts is dedicated to advancing the field of medical imaging for improved patient outcomes.

To arrange a conversation with our proficient medical and scientific affairs experts and discover how we can help your immunotherapy trials with tailored imaging solutions