Egesta Lopci - Atlas of Response to Immunotherapy

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The armamentarium of publications on immunotherapy for oncological use has exponentially increased in the last years. This is a direct consequence of the major impact of immunological-based treatment on cancer and in particular of the wide adoption of checkpoint inhibitors: the assignment of the 2018 Nobel Prize in Physiology or Medicine to the scientists who first described the clinical utility of these new drugs confirms the relevance of the argument. Consequently, there is a proliferation of texts on immunotherapy, and yet, why publish another book on such a topic? When planning the outline of this book, our unique purpose was to answer a clinical demand: how to investigate and interpret the tumor response to immunotherapy. In fact, much is known about principles and the role of immunotherapy, but much less is clear about the best strategy to evaluate the response to therapy, in particular by imaging. Being images the most immediate way to convey knowledge and taking into account our expertise in molecular imaging, we could only choose an atlas as the best format to fit the purpose, to clarify the issue and provide clear examples of clinical use.

Once we set up the aim of the project, the pathway to complete the task passed through the involvement of great experts in the field. Despite the global attempt to assess the benefit of immunotherapy in various oncological settings, the response evaluation by means of imaging can still be considered unsettled. Anatomical imaging is based on morphology alone, therefore, it is not an optimal solution; on the other hand, functional imaging through metabolic tracers can face problems of interpretation. An integrated approach taking advantage of both information is probably the best way to procede, and thus we decided to focus on hybrid imaging with PET/CT. A mindful and malleable way of thinking is nevertheless mandatory when considering hybrid imaging for evaluating the response to therapy: not only clinicians must be aware of the results obtainable on imaging, but most importantly they must know how to use them. Imagers, on the other side, should acquire confidence in reading and documenting results, allowing experience and proper knowledge transpire from the reports. Experience is in fact a key element for every undertaking, even more crucial for medical specialty. This book has focused on this specific element, providing by means of didactic images direct examples of everyday experience with immunotherapy response assessment, not leaving aside exceptions and minority reports. We address the manuscript to every medical specialty involved in the field and to trainees requiring insight on what to expect as specialists from molecular imaging when tumor response to immunotherapy is questioned. Please enjoy the reading!