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Radiologische Responsebeurteilung moderner Immuntherapien mithilfe von iRECIST

Radiological response assessment of modern immunotherapy using iRECIST

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Zusammenfassung

Klinisches/methodisches Problem

In der Onkologie zeigen moderne Immuntherapien mitunter atypische Ansprechmuster mit divergentem Therapieansprechen oder anfänglichem „Pseudoprogress“.

Radiologische Standardverfahren

Response Evaluation Criteria in Solid Tumors (RECIST 1.1) stellen die aktuell am häufigsten angewendeten Responsekriterien für konventionelle Chemotherapien bei soliden Tumoren dar. Atypische Ansprechmuster im Rahmen von Immuntherapien werden hierdurch jedoch nicht korrekt klassifiziert und so die Wirksamkeit mitunter fehlinterpretiert.

Methodische Innovationen

Um diesen atypischen Ansprechmustern gerecht zu werden, wurden kürzlich spezielle „immune-related“ Response Evaluation Criteria in Solid Tumors (iRECIST) publiziert. Im Unterschied zu RECIST 1.1 muss in iRECIST bei klinisch stabilen Tumorleiden ein initial unbestätigter Tumorprogress („unconfirmed progressive disease“, iUPD) durch eine Verlaufskontrolle nach 4 bis 8 Wochen bestätigt werden („confirmed progessive disease“, iCPD). Hierbei werden innerhalb von iRECIST neue Läsionen separat bewertet.

Leistungsfähigkeit

iRECIST ermöglicht eine standardisierte Responseevaluierung unter Berücksichtigung eines möglichen Pseudoprogresses, der in Abhängigkeit der Tumorentität und des Immuntherapeutikums in bis zu ca. 10 % der Fälle vorliegen kann.

Bewertung

Prinzipiell ist iRECIST nur für die Anwendung in klinischen Prüfungen von Immuntherapien entwickelt worden.

Empfehlung für die Praxis

iRECIST kann unter Berücksichtigung der Limitationen in der täglichen Praxis als zusätzliches objektives Responsekriterium herangezogen werden.

Abstract

Clinical/methodical issue

Modern immunotherapies in oncology show tumor response patterns differing from conventional chemotherapies including initial pseudo-progression.

Standard radiological methods

Response evaluation criteria in solid tumors (RECIST 1.1) represent the currently most used response criteria for conventional chemotherapy of solid tumors. However, atypical response patterns of immunotherapies are not correctly classified using RECIST 1.1 so that the effectiveness is also incorrectly interpreted.

Methodical innovations

In order to correctly interpret these atypical response patterns, special immune-related response criteria in solid tumors (iRECIST) have been published. In contrast to RECIST 1.1 according to iRECIST an initially unconfirmed progressive disease (iUPD) requires confirmation (iCPD) in clinically stable patients by subsequent control imaging after 4–8 weeks. New lesions are separately assessed within iRECIST.

Performance

The iRECIST procedure allows a standardized objective assessment of a possible pseudo-progression which can occur in up to 10% of cases depending on the immunomodulating drug and tumor entity.

Achievements

In principle, iRECIST was developed only for usage in trials testing modern immunotherapeutics.

Practical recommendations

The iRECIST procedure might also be helpful as an additional objective response criterium for clinical treatment decisions, taking the limitations into account.

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    T. Persigehl

  2. Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland

    T. D. Poeppel

  3. Abteilung Diagnostische und Interventionelle Radiologie, NCT Heidelberg (DKFZ & Universitätsklinikum HD), Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland

    O. Sedlaczek

Authors
  1. T. Persigehl
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  3. O. Sedlaczek
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Corresponding author

Correspondence to T. Persigehl.

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Interessenkonflikt

T. Persigehl, T.D. Poeppel und O. Sedlaczek geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Persigehl, T., Poeppel, T.D. & Sedlaczek, O. Radiologische Responsebeurteilung moderner Immuntherapien mithilfe von iRECIST. Radiologe 57, 826–833 (2017). https://doi.org/10.1007/s00117-017-0289-9

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