Imaging Biomarkers in Cancer Immunotherapy

Imaging biomarkers have emerged as pivotal tools in the evaluation and optimisation of cancer immunotherapy. By capturing molecular and metabolic changes within tumours and associated tissues, modalities such as 18F-FDG PET/CT, magnetic resonance imaging and advanced computed tomography enable clinicians to monitor treatment response, predict efficacy and detect immune-related adverse events. Beyond conventional semi-quantitative measures, novel workflows integrate image-derived features through radiomics and artificial intelligence to characterise tumour heterogeneity, identify immune‐rich phenotypes and distinguish true progression from pseudoprogression. This non-invasive approach can inform patient stratification, guide adaptive treatment strategies and support early decision-making in diverse malignancies, from lung cancer to melanoma. As immunotherapy regimens expand and combination strategies proliferate, imaging biomarkers will play a critical role in understanding mechanisms of action, optimising dosing schedules and minimising toxicity on a global scale.

Research from Nature Portfolio

Recent studies have demonstrated that quantitative analysis of 18F-FDG uptake can predict response to anti-PD-1 therapy in non-small cell lung cancer. Patients whose tumours exhibit higher maximum standardized uptake values prior to treatment show significantly greater rates of partial response to checkpoint inhibitors. By establishing optimal SUVmax thresholds, this work highlights the potential of routine PET/CT to serve as a predictive biomarker, guiding patient selection and improving clinical outcomes without the need for additional invasive sampling.

Imaging Biomarkers in Cancer Immunotherapy publication trend

The graph below shows the total number of articles in imaging biomarkers in cancer immunotherapy across all publications each year (not limited to Nature Index journals).

Technical terms

Imaging biomarker: A measurable indicator derived from medical imaging that reflects biological processes or responses to therapy.

Immune checkpoint inhibitor: A therapeutic antibody targeting regulatory pathways in T cells to enhance antitumour immunity.

18F-FDG PET/CT: A hybrid imaging technique using a glucose analogue tracer to visualise metabolic activity combined with anatomical CT data.

SUVmax: The maximum standardized uptake value, representing the highest tracer concentration within a lesion on PET imaging.

Radiomics: The extraction and analysis of high‐dimensional quantitative features from medical images to characterise tissue heterogeneity.

Tumour immune microenvironment: The cellular and molecular milieu within and around a tumour that influences immune cell infiltration and function.

References

1. Imaging assessment of toxicity related to immune checkpoint inhibitors. Frontiers in Immunology (2023).
2. A Machine Learning Model Based on PET/CT Radiomics and Clinical Characteristics Predicts Tumor Immune Profiles in Non-Small Cell Lung Cancer: A Retrospective Multicohort Study. Frontiers in Immunology (2022).
3. Cancer immunotherapy is accompanied by distinct metabolic patterns in primary and secondary lymphoid organs observed by non-invasive in vivo 18F-FDG-PET. Theranostics (2020).
4. 18F-FDG uptake in PET/CT is a potential predictive biomarker of response to anti-PD-1 antibody therapy in non-small cell lung cancer. Scientific Reports (2019).