Is there a role for Gallium-67 SPECT in distinguishing progression and pseudoprogresion in oncologic patients receiving immunotherapy?
Immuno-oncology (IO) with immune checkpoint inhibitors (ICIs) is the new landmark in cancer treatment. However, due to its economical-related burden and the possibility of tumor pseudoprogression with late response patterns, it is imperative to find new ways for early discrimination of patients with...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-01-01
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| Series: | Cancer Treatment and Research Communications |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468294221001386 |
| _version_ | 1818871830945988608 |
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| author | Davide Mauri Spyridon Tsiouris Stefania Gkoura Ioanna Gazouli Panagiotis Ntellas Annalea Amylidis Lefteris Kampletsas Andreas Fotopoulos |
| author_facet | Davide Mauri Spyridon Tsiouris Stefania Gkoura Ioanna Gazouli Panagiotis Ntellas Annalea Amylidis Lefteris Kampletsas Andreas Fotopoulos |
| author_sort | Davide Mauri |
| collection | DOAJ |
| description | Immuno-oncology (IO) with immune checkpoint inhibitors (ICIs) is the new landmark in cancer treatment. However, due to its economical-related burden and the possibility of tumor pseudoprogression with late response patterns, it is imperative to find new ways for early discrimination of patients with IO-sensitive versus IO-resistant disease. ICI-mediated antitumor responses depend on tumor immune infiltration by T-cells capable of recognizing and killing tumor cells. Nevertheless, patients may experience different responses to immunotherapy according to their tumor microenvironment and inflammatory infiltration. T-cell infiltrated tumors are referred to as ‘hot’ and are potential candidates for a good response to ICIs, whereas ‘cold’ are those tumors lacking T-cell infiltration and exhibit a narrow likelihood of response to IO therapy. Gallium-67 (67Ga) scintigraphy may hold potential for separating ‘hot’ from ‘cold’ tumors, thus providing an imaging tool to distinguish ‘hot’ ICI-induced pseudoprogression from real early ‘cold’ progression. Even so, various tumors (lymphomas, lung cancer, breast cancer, hepatoma, malignant melanoma) exhibit an inherent affinity for 67Ga that is independent of the ICI-induced immune infiltration, and this raises issues about false positivity. For that reason, future investigational studies to evaluate the prospective role of this radiotracer in the early prediction of ICI response should be confined to tumors with an inherently low 67Ga affinity (thyroid carcinoma, gastrointestinal and genitourinary tract tumors). We describe our experience with a patient with recurrent metastatic lung adenocarcinoma under ICI therapy that was submitted to 67Ga scanning for a fever of unknown origin and we discuss the aforementioned topics, alongside current imaging trends and future perspectives in the field. |
| first_indexed | 2024-12-19T12:29:09Z |
| format | Article |
| id | doaj.art-220a79b13d024fa8b3e952e7723e3819 |
| institution | Directory Open Access Journal |
| issn | 2468-2942 |
| language | English |
| last_indexed | 2024-12-19T12:29:09Z |
| publishDate | 2021-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Cancer Treatment and Research Communications |
| spelling | doaj.art-220a79b13d024fa8b3e952e7723e38192022-12-21T20:21:27ZengElsevierCancer Treatment and Research Communications2468-29422021-01-0128100441Is there a role for Gallium-67 SPECT in distinguishing progression and pseudoprogresion in oncologic patients receiving immunotherapy?Davide Mauri0Spyridon Tsiouris1Stefania Gkoura2Ioanna Gazouli3Panagiotis Ntellas4Annalea Amylidis5Lefteris Kampletsas6Andreas Fotopoulos7Department of Medical Oncology, University Hospital of Ioannina, Ioannina, GreeceNuclear Medicine Department, University Hospital of Ioannina, Ioannina, GreeceDepartment of Medical Oncology, University Hospital of Ioannina, Ioannina, Greece; Corresponding author at: MD, Department of Medical Oncology, University Hospital of Ioannina, S. Niarchos Avenue, TK 45500, Ioannina, GreeceDepartment of Medical Oncology, University Hospital of Ioannina, Ioannina, GreeceDepartment of Medical Oncology, University Hospital of Ioannina, Ioannina, GreeceDepartment of Medical Oncology, University Hospital of Ioannina, Ioannina, GreeceDepartment of Medical Oncology, University Hospital of Ioannina, Ioannina, GreeceNuclear Medicine Department, University Hospital of Ioannina, Ioannina, GreeceImmuno-oncology (IO) with immune checkpoint inhibitors (ICIs) is the new landmark in cancer treatment. However, due to its economical-related burden and the possibility of tumor pseudoprogression with late response patterns, it is imperative to find new ways for early discrimination of patients with IO-sensitive versus IO-resistant disease. ICI-mediated antitumor responses depend on tumor immune infiltration by T-cells capable of recognizing and killing tumor cells. Nevertheless, patients may experience different responses to immunotherapy according to their tumor microenvironment and inflammatory infiltration. T-cell infiltrated tumors are referred to as ‘hot’ and are potential candidates for a good response to ICIs, whereas ‘cold’ are those tumors lacking T-cell infiltration and exhibit a narrow likelihood of response to IO therapy. Gallium-67 (67Ga) scintigraphy may hold potential for separating ‘hot’ from ‘cold’ tumors, thus providing an imaging tool to distinguish ‘hot’ ICI-induced pseudoprogression from real early ‘cold’ progression. Even so, various tumors (lymphomas, lung cancer, breast cancer, hepatoma, malignant melanoma) exhibit an inherent affinity for 67Ga that is independent of the ICI-induced immune infiltration, and this raises issues about false positivity. For that reason, future investigational studies to evaluate the prospective role of this radiotracer in the early prediction of ICI response should be confined to tumors with an inherently low 67Ga affinity (thyroid carcinoma, gastrointestinal and genitourinary tract tumors). We describe our experience with a patient with recurrent metastatic lung adenocarcinoma under ICI therapy that was submitted to 67Ga scanning for a fever of unknown origin and we discuss the aforementioned topics, alongside current imaging trends and future perspectives in the field.http://www.sciencedirect.com/science/article/pii/S2468294221001386Immuno-oncologyImmune checkpoint inhibitorPseudoprogression‘Hot’ & ‘cold’ tumorGallium-67SPECT/CT |
| spellingShingle | Davide Mauri Spyridon Tsiouris Stefania Gkoura Ioanna Gazouli Panagiotis Ntellas Annalea Amylidis Lefteris Kampletsas Andreas Fotopoulos Is there a role for Gallium-67 SPECT in distinguishing progression and pseudoprogresion in oncologic patients receiving immunotherapy? Cancer Treatment and Research Communications Immuno-oncology Immune checkpoint inhibitor Pseudoprogression ‘Hot’ & ‘cold’ tumor Gallium-67 SPECT/CT |
| title | Is there a role for Gallium-67 SPECT in distinguishing progression and pseudoprogresion in oncologic patients receiving immunotherapy? |
| title_full | Is there a role for Gallium-67 SPECT in distinguishing progression and pseudoprogresion in oncologic patients receiving immunotherapy? |
| title_fullStr | Is there a role for Gallium-67 SPECT in distinguishing progression and pseudoprogresion in oncologic patients receiving immunotherapy? |
| title_full_unstemmed | Is there a role for Gallium-67 SPECT in distinguishing progression and pseudoprogresion in oncologic patients receiving immunotherapy? |
| title_short | Is there a role for Gallium-67 SPECT in distinguishing progression and pseudoprogresion in oncologic patients receiving immunotherapy? |
| title_sort | is there a role for gallium 67 spect in distinguishing progression and pseudoprogresion in oncologic patients receiving immunotherapy |
| topic | Immuno-oncology Immune checkpoint inhibitor Pseudoprogression ‘Hot’ & ‘cold’ tumor Gallium-67 SPECT/CT |
| url | http://www.sciencedirect.com/science/article/pii/S2468294221001386 |
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