Immune Checkpoint Inhibitor–Related Adverse Effects and<sup>18</sup>F-FDG PET/CT Findings

Schierz, Jan-Henning; Sarıkaya, İsmet; Wollina, Uwe; Unger, L.; Sarıkaya, Ali

doi:10.2967/jnmt.121.262151

Cited by 16 publications

(24 citation statements)

References 33 publications

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“…18 F-FDG PET/CT is frequently used to evaluate tumors and treatment efficacy. Although there are no guidelines or consensus for the detection of irAEs by imaging, it is also a useful technique to evaluate irAEs [ 25 ]. 18 F-FDG PET has high sensitivity in detecting rheumatic irAEs and determining their extent and severity, information that is important in patient management [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although there are no guidelines or consensus for the detection of irAEs by imaging, it is also a useful technique to evaluate irAEs [ 25 ]. 18 F-FDG PET has high sensitivity in detecting rheumatic irAEs and determining their extent and severity, information that is important in patient management [ 25 ]. However, the incidence of synovitis with 18 F-FDG PET/CT could be under-estimated, because not all joint regions, including the feet, are covered by this technique [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are few reports about the role that imaging tests play in patients who develop irAEs [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. This study aimed to describe the imaging test findings associated with the different clinical patterns in patients with ICI-induced arthritis in patients treated at our hospital.…”

Section: Introductionmentioning

confidence: 99%

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Imaging Findings in Patients with Immune Checkpoint Inhibitor-Induced Arthritis

et al. 2022

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Immune checkpoint inhibitor (ICI)-induced arthritis is an increasingly recognized adverse event in patients with oncologic disease during immunotherapy. Four patterns are well described, including rheumatoid arthritis (RA)-like, polymyalgia rheumatica (PMR)-like, psoriatic arthritis (PsA)-like, and oligo-monoarthritis, among others. Despite better clinical recognition of these syndromes, information about the main imaging findings is limited. Methods: We conducted a retrospective observational study including all adult patients referred to the Rheumatology Department of a single-center due to ICI-induced arthritis who underwent imaging studies [ultrasound (US), magnetic resonance imaging (MRI), and 18F-FDG PET/CT)] between January 2017 and January 2022. Results: Nineteen patients with ICI-induced arthritis with at least one diagnostic imaging assessment were identified (15 US, 4 MRI, 2 18F-FDG PET/CT). Most patients were male (84.2%), with a median age at inclusion of 73 years. The main underlying diagnoses for ICI treatment were melanoma in five cases. The distribution of ICI-induced arthritis was as follows: PMR-like (5, 26.2%), RA-like (4, 21.1%), PsA-like (4, 21.1%), and others (6, 31.6%). All RA-like patients had US findings indistinguishable from conventional RA patients. In addition, 3/5 (60%) of PMR-like patients had significant involvement of the hands and wrists. Abnormal findings on MRI or PET-CT were reported by clinical symptoms. No erosions or myofascitis were seen. Conclusions: ICI-induced arthritis patients present inflammatory patterns on imaging studies similar to conventional inflammatory arthropathies, and therefore these syndromes should be followed carefully and treated according to these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Imaging Findings in Patients with Immune Checkpoint Inhibitor-Induced Arthritis

et al. 2022

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“…There are several previous case reports of radiographic ndings associated with irAE on 18 F-FDG PET/CT [30]. In the case of thyroiditis, intense diffuse radiotracer uptake in the thyroid was reported in previous studies [31].…”

Section: Discussionmentioning

confidence: 81%

Quantitative Imaging Biomarkers of Immune-Related Adverse Events in Immune-Checkpoint Blockade-Treated Metastatic Melanoma Patients: a Pilot Study

Hribernik

Huff

Studen

et al. 2021

Preprint

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Purpose To develop quantitative molecular imaging biomarkers of immune-related adverse event (irAE) development in malignant melanoma (MM) patients receiving immune-checkpoint inhibitors (ICI) imaged with 18F-FDG PET/CT.Methods 18F-FDG PET/CT images of 58 MM patients treated with anti-PD-1 or anti-CTLA-4 ICI were retrospectively analyzed for indication of irAE. Three target organs, most commonly affected by irAE, were considered: bowel, lung, and thyroid. Patient charts were reviewed to identify which patients experienced irAE, irAE grade, and time to irAE diagnosis. Target organs were segmented using a convolutional neural network (CNN), and novel quantitative imaging biomarkers – SUV percentiles (SUVX%) of 18F-FDG uptake within the target organs – were correlated with the clinical irAE status. Area under the receiver-operating characteristic curve (AUROC) was used to quantify irAE detection performance. Patients who did not experience irAE were used to establish normal ranges for target organ 18F-FDG uptake.Results A total of 31% (18/58) patients experienced irAE in the three target organs: bowel (n=6), lung (n=5), and thyroid (n=9). Optimal percentiles for identifying irAE were: bowel (SUV95%, AUROC=0.79), lung (SUV95%, AUROC=0.98), and thyroid (SUV75%, AUROC=0.88). Optimal cut-offs for irAE detection were: bowel (SUV95%>2.7 g/mL), lung (SUV95%>1.7 g/mL), and thyroid (SUV75%>2.1 g/mL). Normal ranges (95% confidence interval) for the SUV percentiles in patients without irAE were: bowel [1.74, 2.86 g/mL], lung [0.73, 1.46 g/mL], and thyroid [0.86, 1.99 g/mL].Conclusions Increased 18F-FDG uptake within irAE-affected organs provides predictive information about the development of irAE in MM patients receiving ICI and represents a potential quantitative imaging biomarker for irAE. Some irAE can be detected on 18F-FDG PET/CT well before clinical symptoms appear.

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“…Moreover, traditional chemotherapy would cause multiple side effects, including gastrointestinal toxicity (loss of appetite, nausea, vomiting, diarrhea, malabsorption and disorders), myelosuppression, liver and kidney function damage, etc ( 37 ). Immune checkpoint inhibitor would also cause side effects, including cardiotoxicity, abnormal liver function, kidney failure, etc ( 38 ). Side effects from both chemotherapy and immune checkpoint inhibitor would decrease patient’s tolerability, leading to increased drop out rate or prolonged treatment interval among cancer patients receiving this combination therapy.…”

Section: Mechanism and Therapeutic Effect Of Chemotherapy Plus Immune...mentioning

confidence: 99%

Nano-Chemotherapy synergize with immune checkpoint inhibitor- A better option?

2022

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Immune checkpoint inhibitor (ICI) is one of the most important tumor treatment methods. Although the therapeutic efficiency of immune checkpoint inhibitor mono-therapy is limited, the combination of chemotherapy plus immune checkpoint inhibitors has shown great advantages in cancer treatment. This is mainly due to the fact that tumor reactive T cells could fully provide their anti-tumor function as chemotherapy could not only cause immunogenic cell death to increase antigen presentation, but also improve the immunosuppressive tumor micro-environment to synergize with immune checkpoint inhibitors. However, traditional chemotherapy still has shortcomings such as insufficient drug concentration in tumor region, short drug duration, drug resistance, major adverse events, etc, which might lead to the failure of the therapy. Nano chemotherapeutic drugs, which refer to chemotherapeutic drugs loaded in nano-based drug delivery system, could overcome the above shortcomings of traditional chemotherapeutic drugs to further improve the therapeutic effect of immune checkpoint inhibitors on tumors. Therefore, the scheme of nano chemotherapeutic drugs combined with immune checkpoint inhibitors might lead to improved outcome of cancer patients compared with the scheme of traditional chemotherapy combined with immune checkpoint inhibitors.

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Immune Checkpoint Inhibitor–Related Adverse Effects and¹⁸F-FDG PET/CT Findings

Cited by 16 publications

References 33 publications

Imaging Findings in Patients with Immune Checkpoint Inhibitor-Induced Arthritis

Imaging Findings in Patients with Immune Checkpoint Inhibitor-Induced Arthritis

Quantitative Imaging Biomarkers of Immune-Related Adverse Events in Immune-Checkpoint Blockade-Treated Metastatic Melanoma Patients: a Pilot Study

Nano-Chemotherapy synergize with immune checkpoint inhibitor- A better option?

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Immune Checkpoint Inhibitor–Related Adverse Effects and18F-FDG PET/CT Findings

Cited by 16 publications

References 33 publications

Imaging Findings in Patients with Immune Checkpoint Inhibitor-Induced Arthritis

Imaging Findings in Patients with Immune Checkpoint Inhibitor-Induced Arthritis

Quantitative Imaging Biomarkers of Immune-Related Adverse Events in Immune-Checkpoint Blockade-Treated Metastatic Melanoma Patients: a Pilot Study

Nano-Chemotherapy synergize with immune checkpoint inhibitor- A better option?

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Immune Checkpoint Inhibitor–Related Adverse Effects and¹⁸F-FDG PET/CT Findings