Turning a vision into a reality.

Top Line: There’s no question immune checkpoint inhibition has changed the face of oncology, but offering it would be even sweeter if we could better identify those who benefit most.

The Tech: While PD-L1 expression and even more sophisticated gene panels are something, it's all still a pretty rough and dirty snippet of a dauntingly complex tumor-immune relationship that is ever-evolving. Here’s a fascinating review of emerging immune-PET tracers that is worth a perusal if for no other reason than the A+ writing that paints some lovely images of the “spatial and temporal heterogeneity” uniquely captured by this amazing technology. There are also some lovely images, literally–just check out the figures. The concept is that any of the readily available immune checkpoint inhibitors can be tagged to a positron-emitting radioisotope to provide an individualized map of not only anatomic targets but also the ability of drugs to engage with targets on a case by case basis. And all of this can be achieved throughout the clinical course at different timepoints in therapy. We can all agree—ok, except for eviCore—that it’s simply not feasible to call for dozens of trials with thousands of patients to determine just where radiation fits into the treatment paradigm across every histology, anatomic tumor site, and clinical history of metastatic disease. What if, instead, we could refine these imaging techniques to help us determine not only which patients are most likely to benefit from immune checkpoint inhibition prior to signing them up for months of treatment but also which lesions at which time point make for the best synergistic radiation targets?

TBL: Tumor agnostic immune-PET scans may prove to be the North Star we’ve all been looking for in determining when to initiate and/or discontinue immune checkpoint inhibitors as well as when and where to overlay local therapies. | Hegi-Johnson, NPJ Precis Oncol 2022