Can radiomics personalise immunotherapy?

Immunotherapy by immune checkpoint blockade has emerged as a promising therapeutic option for patients with aggressive tumours. However, the inability to precisely identify the patients who will benefit from these treatments has limited the applicability of immune checkpoint blockade and could put patients at higher risk of immune-related toxicity. Expression of programmed cell death ligand-1 (PD-L1) is a commonly used biomarker that indicates to physicians whether a patient should or should not receive immune checkpoint blockade therapy; this method has been inconsistent and unreliable because of its variability and spatial intratumoral heterogeneity. 1 McLaughlin J Han G Schalper KA et al. Quantitative assessment of the heterogeneity of PD-L1 expression in non-small-cell lung cancer. JAMA Oncol. 2016; 2: 46-54 Crossref PubMed Scopus (612) Google Scholar A phase 3 trial 2 Carbone DP Reck M Paz-Ares L et al. First-line nivolumab in stage IV or recurrent non-small-cell lung cancer. N Engl J Med. 2017; 376: 2415-2426 Crossref PubMed Scopus (1711) Google Scholar that compared immune checkpoint blockade and chemotherapy showed no difference between these treatments in the overall survival of patients with increased PD-L1 expression in solid tumours of 5% or more. Therefore, new biomarkers that could integrate several approaches are sought, to stratify patients to receive the most appropriate immunotherapy approaches and for early prediction of patient response to immune checkpoint blockade. 3 Gibney GT Weiner LM Atkins MB Predictive biomarkers for checkpoint inhibitor-based immunotherapy. Lancet Oncol. 2016; 17: e542-e551 Summary Full Text Full Text PDF PubMed Scopus (975) Google Scholar A radiomics approach to assess tumour-infiltrating CD8 cells and response to anti-PD-1 or anti-PD-L1 immunotherapy: an imaging biomarker, retrospective multicohort studyThe radiomic signature of CD8 cells was validated in three independent cohorts. This imaging predictor provided a promising way to predict the immune phenotype of tumours and to infer clinical outcomes for patients with cancer who had been treated with anti-PD-1 and PD-L1. Our imaging biomarker could be useful in estimating CD8 cell count and predicting clinical outcomes of patients treated with immunotherapy, when validated by further prospective randomised trials. Full-Text PDF