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Head and neck squamous cell carcinomas (HNSCC) pose a significant challenge in oncology, particularly in advanced or recurrent/metastatic cases where conventional therapies have limited efficacy. The emergence of immune checkpoint inhibitors (ICIs) targeting programmed cell death-1 (PD-1) and programmed death ligand 1 (PD-L1) has provided new therapeutic opportunities. This chapter explores the role of radiological imaging, particularly positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI), in monitoring and predicting responses to PD-1/PD-L1 inhibitors in HNSCC. The study demonstrates that PET/CT and MRI are critical in monitoring treatment response to PD-1/PD-L1 inhibitors in HNSCC. 18-Fluorodeoxyglucose (18F-FDG) PET/CT effectively tracks metabolic changes in tumors, with metabolic tumor volume (MTV) and total lesion glycolysis (TLG) emerging as superior predictive biomarkers compared to SUVmax. Novel PET radiotracers targeting PD-L1 expression offer the potential for improved response assessment. MRI-based imaging provides functional insights into tumor perfusion, hypoxia, and immune interactions, particularly dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI-MRI). Changes in apparent diffusion coefficient (ADC) values have shown strong correlations with treatment response, while DCE-MRI parameters such as Ktrans and Kep are associated with PD-L1 expression, suggesting their potential as imaging biomarkers. The integration of PET/CT and MRI has significantly enhanced the monitoring of PD-1/PD-L1 therapy responses in HNSCC. Despite challenges in distinguishing immune-related changes and tumor heterogeneity, radiolabeled PD-1/PD-L1 antibodies, AI-driven radiomics, and novel PET tracers offer promising advancements. Future research should focus on standardizing imaging protocols and integrating multimodal approaches to optimize immunotherapy monitoring and improve patient outcomes.

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The Use of Radiology Imaging in Monitoring Treatment Response to PD-1/PD-L1 Inhibitors in Head and Neck Squamous Cell Carcinomas

  • 章节

  • 发表日期：

    2025年

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  • Soha Mohammadi,
  • Shaghayegh Khanmohammadi,
  • Nima Taghizadeh Mortezaei,
  • Nima Rezaei

摘要

Head and neck squamous cell carcinomas (HNSCC) pose a significant challenge in oncology, particularly in advanced or recurrent/metastatic cases where conventional therapies have limited efficacy. The emergence of immune checkpoint inhibitors (ICIs) targeting programmed cell death-1 (PD-1) and programmed death ligand 1 (PD-L1) has provided new therapeutic opportunities. This chapter explores the role of radiological imaging, particularly positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI), in monitoring and predicting responses to PD-1/PD-L1 inhibitors in HNSCC. The study demonstrates that PET/CT and MRI are critical in monitoring treatment response to PD-1/PD-L1 inhibitors in HNSCC. 18-Fluorodeoxyglucose (18F-FDG) PET/CT effectively tracks metabolic changes in tumors, with metabolic tumor volume (MTV) and total lesion glycolysis (TLG) emerging as superior predictive biomarkers compared to SUVmax. Novel PET radiotracers targeting PD-L1 expression offer the potential for improved response assessment. MRI-based imaging provides functional insights into tumor perfusion, hypoxia, and immune interactions, particularly dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI-MRI). Changes in apparent diffusion coefficient (ADC) values have shown strong correlations with treatment response, while DCE-MRI parameters such as Ktrans and Kep are associated with PD-L1 expression, suggesting their potential as imaging biomarkers. The integration of PET/CT and MRI has significantly enhanced the monitoring of PD-1/PD-L1 therapy responses in HNSCC. Despite challenges in distinguishing immune-related changes and tumor heterogeneity, radiolabeled PD-1/PD-L1 antibodies, AI-driven radiomics, and novel PET tracers offer promising advancements. Future research should focus on standardizing imaging protocols and integrating multimodal approaches to optimize immunotherapy monitoring and improve patient outcomes.