Over recent years, the role of the immune system in controlling tumourigenesis and tumour progression has been well established, and immunotherapy has become an entrenched pillar of cancer treatment, improving the prognosis of many patients with a broad variety of malignancies. In today’s State of the Art Symposium entitled ‘Immunotherapy: what the radiologist needs to know’ experts will discuss this hot topic from different angles, followed by a period of questions and answers.

When one thinks of the immune system, one thinks in particular of an endogenous system defending the body against infectious organisms. However, this is not the immune system’s only protective function; it also helps to eradicate malignancies when, for example, stimulated through strengthening of the host immune responses against tumours or supplying modified immune system components.

The conscious integration of the immune system into oncological therapy (hence the term oncological immunotherapy) includes various therapies using substances to stimulate or suppress the immune system in order to help the organism to fight cancer.

FDG PET/CT of a patient with malignant melanoma who received immunotherapy. Left: before treatment, right: after treatment (provided by Dr. Chikako Suzuki, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm).

“In sum, it is a type of cancer treatment that increases the body’s natural defences to fight cancer. It uses substances made by the body or in a laboratory to improve or restore the function of the immune system, aiming to slow down or stop the growth of cancer cells and thus to also stop the cancer from spreading into other parts of the body and to support the immune system in destroying cancer cells,” said the chair of today’s session, Prof. Jacob Sosna, Director of the Department of Radiology and Medical Imaging at the Hadassah Medical Center, Jerusalem.

Today, immunotherapy is a standard treatment for a wide range of cancer malignancies. Besides surgery, chemotherapy, radiation and targeted therapy, it is one of the key pillars of cancer therapy, if not even the basic pillar, according to Sosna.

“Immunotherapy is a groundbreaking cancer treatment. In recent years, there has been a great deal of investigation and progress in immunotherapy. Meanwhile, its clinical uses include a variety of cancers such as lung and colon cancer and melanoma. Immune modulation is also used to enhance the use of ablative techniques in order to maximise their impact and to minimise systemic effects of accelerated tumour development after the ablation of tumours mediated by the immune system,” he explained. For radiologists, it is more and more important to be familiar with the mechanisms of this therapy and the implications in tumour assessment in cross-sectional imaging as well as in interventional oncology (IO).

The former will be the key topic of the presentation by Dr. Chikako Suzuki, from the Department of Molecular Medicine and Surgery at Karolinska Institute, Stockholm, who plans to go over the current practice of oncology evaluation in cross-sectional imaging point-by-point and provide an update on novel anti-cancer agents and novel treatment-related reactions.

Cross-sectional imaging is used at different points along the pathway of patient care, starting with the initial diagnosis, staging of disease extent and monitoring response to treatment through evaluation of residual masses after treatment, up to confirmation of remission and recognition of complications of treatment.

Before Suzuki’s lecture, Prof. Tony Ng, Joint Head of the School of Cancer and Pharmaceutical Sciences at King’s College London, will familiarise ECR delegates with the basic changes in the immune system in oncology patients and the means by which immunotherapy can be used.

Last, but not least, Prof. S. Nahum Goldberg, Head of the Interventional Oncology Unit and Director of the Applied Radiology Research Laboratory at Hadassah Medical Center, will discuss the current practice of IO, a subspecialty field of interventional radiology addressing the diagnosis and treatment of cancer and cancer-related problems by the use of targeted minimally-invasive procedures performed with image guidance. These include transarterial chemoembolisation (TACE), a transcatheter procedure for hepatocellular carcinoma, which involves the embolisation of the tumour feeding vessels with embolic particles; selective internal radiation therapy (SIRT), also a transcatheter therapy and treatment method for the management of non-resectable hepatic malignancies; and radiofrequency ablation (RFA), an ablative therapy involving the destruction of the lesion with a percutaneously placed needle. During the lecture, attendees will discover applications in which the immune system can be modulated by IO, as well as challenges and opportunities of immune system modulation in IO.

LIVE
State of the Art Symposium, Sunday, July 19, 15:30–16:30
SA 9 Immunotherapy: what the radiologist needs to know

  • Chairperson’s introduction
    Jacob Sosna; Jerusalem/IL
  • Immunotherapy: the basics for radiologists
    Tony Ng; London/UK
  • Assessment of tumour response
    Chikako Suzuki; Stockholm/SE
  • The immune response in interventional oncology: challenges and opportunities
    Nahum Goldberg; Jerusalem/IL
  • Live Q&A: Role of radiologists in immunotherapy

FURTHER READING

Kitajima K, Okada M, Kashiwagi T et al (2019) Early evaluation of tumor response to 90Y-ibritumomab radioimmunotherapy in relapsed/refractory B cell non-Hodgkin lymphoma: what is the optimal timing for FDG-PET/CT? Eur Radiol. 29(7):3935-3944: european-radiology.org/6134

Harrington K, Halpenny DF (2017) Cancer Immunotherapy – What the Radiologist Needs to Know. ECR 2017 / C-2015: myESR.org/172015

Samouco LHCB, Rodrigues SL, Santos JG, Soares DF, Magalhães MJ, Gouvêa M (2019) New drugs, new toxicities: recognizing the radiological spectrum of cancer immunotherapy adverse effects. ECR 2019 / C-3781: myESR.org/193781

Aarts BM, Klompenhouwer EG, Rice SL et al (2019) Cryoablation and immunotherapy: an overview of evidence on its synergy. Insights Imaging. 10(1):53: i3-journal.org/727

Du Y, Jin Y, Sun W, Fang J, Zheng J, Tian J (2019) Advances in molecular imaging of immune checkpoint targets in malignancies: current and future prospect. Eur Radiol. 29(8):4294-4302: european-radiology.org/5814