This article systematically reviews imaging evaluation strategies and toxicity monitoring for antibody-drug conjugates (ADCs) in advanced bladder cancer treatment, providing radiologists with critical clinical decision support information.
Literature Overview
This article, 'State-of-the-Art Imaging in Antibody-Drug Conjugate Treatment for Advanced Bladder Cancer' published in the Korean Journal of Radiology, reviews and summarizes the application of imaging assessments for antibody-drug conjugates in treating advanced bladder cancer, including the role of CT, multiparametric MRI, and FDG-PET/CT in monitoring treatment response and toxicity. It also explores ADC resistance mechanisms and proposes the need for next-generation ADC development.
Background Knowledge
Bladder cancer is a common and challenging urothelial tumor, particularly in its advanced stages, where treatment options are limited and traditional chemotherapy and immunotherapy demonstrate suboptimal efficacy. Antibody-drug conjugates (ADCs) such as enfortumab vedotin and trastuzumab deruxtecan offer new therapeutic hope for advanced bladder cancer patients by combining the targeting capabilities of monoclonal antibodies with the cytotoxic effects of chemotherapeutic agents. However, mechanistic resistance mechanisms like antigen loss or payload resistance may emerge during ADC treatment, affecting therapeutic outcomes. Imaging plays a crucial role in treatment evaluation, with techniques such as CT urography (CTU), multiparametric MRI (mpMRI), and FDG-PET/CT aiding in tumor response assessment, recurrence detection, and identification of drug-related toxicities. Additionally, the VI-RADS scoring system has been employed for mpMRI assessment of treatment response, improving evaluation consistency. Although ADC treatment response evaluation primarily relies on RECIST 1.1 criteria, its application in bladder cancer presents specific challenges, such as variations in bladder wall thickness that may compromise assessment accuracy. Therefore, radiologists must understand the imaging characteristics associated with ADC treatment to optimize patient management.
Research Methods and Experiments
The article provides a detailed analysis of imaging evaluation methods for ADC treatment in advanced bladder cancer, including the application of CT, MRI, and FDG-PET/CT in assessing treatment response, recurrence detection, and toxicity monitoring. It also reviews major resistance mechanisms encountered during ADC treatment, such as antigen downregulation, binding site mutations, accelerated drug clearance, and changes in payload targets. Furthermore, the literature discusses standardized evaluation protocols for imaging techniques in ADC treatment, including the nacVI-RADS scoring system for assessing response in neoadjuvant therapy.
Key Conclusions and Perspectives
Research Significance and Prospects
The article emphasizes the importance of imaging in ADC treatment, highlighting that future research should focus on developing next-generation ADCs to overcome antigen loss and payload resistance challenges. Additionally, imaging applications in neoadjuvant therapy require further standardization to improve therapeutic decision-making capabilities.
Conclusion
The treatment landscape for advanced bladder cancer is being revolutionized by ADCs, with imaging playing an increasingly critical role. This article offers systematic guidance for radiologists covering imaging evaluation criteria, treatment response patterns, toxicity identification, and the application of multiparametric MRI in therapeutic assessment. As ADC technology continues to advance, the role of imaging in treatment evaluation will further expand, providing robust support for personalized therapeutic strategies.
