Synopsis

Keywords: Education Committee: Clinical MRI

The primary focus of this talk is to discuss the evaluation criteria, advanced imaging protocols and new imaging biomarkers to assess treatment response in cancer patients treated with novel targeted and immune-therapies. For decades, one-dimensional measurements of a targeted tumor lesion (mostly based on sequential CT and sometimes MRI, depending on the site of malignancies) have been used as Response Evaluation Criteria in Solid Tumors (RECIST) to cytotoxic chemotherapeutics. Clinical needs for advanced MRI protocols (DWI, DCE-MRI, complementary PET) for early response to cytostatic signal transduction inhibitors and RECIST modification for checkpoint inhibitors (iRECIST) will be discussed.

Synopsis

Cancer treatment has flourished over the past decades, taking an advantage of rapid developments in molecular biology, pharmacology and immunology. The recent developments include signal transduction inhibitors (often referred as targeted therapies) and immunotherapies used to re-routing the immune system to detect and remove cancerous cells. The introduction of cytostatic targeted drugs and immunotherapies has a significant impact in radiology and what radiologic criteria we apply to monitor the treatment response. The focus of this presentation will be on providing the rationale of developing new physiologically-based MRI protocols (DWI, DCE-MRI, and complementary PET) to assess early response to cytostatic signal transduction inhibitors as well as modifying the existing RECIST standards of tumors treated with immunotherapy (iRECIST). Clinical examples will be provided to demonstrate the differences in tumor response to signal transduction inhibitors (early metabolic and cytostatic response) and to checkpoint inhibitors (initial pseudoprogression) as compared to chemotherapeutic drugs, raising questions about the assessment of changes in tumor burden as an objective treatment response.

Keywords

Cancer; Treatment response; Imaging biomarkers; Pseudo-progression

Objectives

During this talk, the participants will refresh their knowledge in the different classes of targeted and immunotherapies for cancer treatment. The limitations of one-dimensional RECIST criteria for tumor burden as objective treatment response will be discussed. The participants will learn practical case examples on early treatment response and pseudo progression. This educational talk will have three objectives:
1. Update on novel treatment options in cancer treatment, including signal transduction inhibitors and checkpoint inhibitors
2. Understand the limitations of one-dimensional assessment of tumor burden when following on early treatment response with targeted agents and immunotherapies
3. Gain practical knowledge on novel physiological imaging biomarkers for treatment response to targeted cytostatic drugs and guideline for using iRECIST in oncologic patients under immunotherapies.

Acknowledgements

No acknowledgement found.

References

No reference found.