Integrating [18F]-Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography with Radiation Therapy and Immunomodulation in Precision Therapy for Solid Tumors

Abstract

[18F]-FDG positron emission tomography with computed tomography (PET/CT) imaging is widely used to enhance the quality of care in patients diagnosed with cancer. Furthermore, it holds the potential to offer insight into the synergic effect of combining radiation therapy (RT) with immuno-oncological (IO) agents. This is achieved by evaluating treatment responses both at the RT and distant tumor sites, thereby encompassing the phenomenon known as the abscopal effect. In this context, PET/CT can play an important role in establishing timelines for RT/IO administration and monitoring responses, including novel patterns such as hyperprogression, oligoprogression, and pseudoprogression, as well as immune-related adverse events. In this commentary, we explore the incremental value of PET/CT to enhance the combination of RT with IO in precision therapy for solid tumors, by offering supplementary insights to recently released joint guidelines.

Clinical Application of ImmunoPET Targeting Checkpoint Inhibitors

“…The potential clinical relevance of ImmunoPET is undeniable because the immune system and the components of the TME are renowned predictive and prognostic factors of treatment benefits and patient outcomes, limited not only to immunotherapy but also to other regimens. Of particular interest is the synergic effect of combining radiation therapy (RT) with immunomodulatory agents and the expected abscopal effect, which can be explained as being mainly based on immune-mediated component activation, leading to cancer-cell death at distant sites from radiation [53]. Furthermore, the complementary use of ImmunoPET with metabolic imaging could maximize the ability to characterize tumor tissues and assess their responsivity to specific treatments, even more emphasized by the advent of texture analyses and artificial intelligence (AI) [54] in image interpretations.…”