Usage of AI With PET/CT Images Could Detect Impacts of Immunotherapy in Lung Cancer

An artificial intelligence (AI) analysis of positron emission tomography-computed tomography (PET/CT) images could potentially predict the occurrence of interstitial lung disease (ILD), which is a serious adverse event (AE) of immunotherapy in lung cancer.¹

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"PET/CT is generally performed to detect cancer metastasis, but it would potentially be useful for estimating the risks of side effects associated with cancer treatment,” Tatsuya Yamazaki, BE, ME PhD, from Niigata University, said in a press release.¹

According to the American Lung Association, ILD is a large group of diseases that cause fibrosis of the lungs. The scarring results in stuffiness in the lungs, making it difficult to breathe and carry oxygen to the bloodstream. The most common symptom of the disease is shortness of breath, but could also include dry cough, chest discomfort, fatigue, and weight loss.²

Individuals with ILD are at an 3.5 to 7.3-times higher at risk of developing lung cancer, regardless of the type of ILD. It is often difficult to diagnose lung cancer among individuals with the disease as there are no ILD-specific guidelines for lung cancer screening. Lung cancer treatment requires specific attention to ILD-related risks of cancer treatment, following a diagnosis among individuals with ILD.³

Immunotherapy has become a beneficial treatment for lung cancer, which uses medications to activate the immune system to fight cancer cells.⁴ However, ILD has been linked as an AE of immunotherapy, but it is difficult to foresee the occurrence induced by medicine.¹

A team of researchers from Niigata University in Japan conducted a retrospective study that assessed the incidence of ILD among 165 individuals with lung cancer that received immunotherapy at Niigata University Medical and Dental Hospital. The investigators included individuals with primary lung cancer were required to undergo fluorodeoxyglucose (FDG)-PET/CT within 3 months prior to immunotherapy. AI was then used for extracting the noncancerous lung from the lung contralateral to the primary tumor, qualifying the degree on inflammation in noncancerous lungs.¹

The results displayed that, among 165 individuals, 28 developed ILD. Further results demonstrated that the risk of developing ILD after immunotherapy was 6.5 times higher in individuals that experiences high inflammation in the noncancerous lung compared to those with low inflammation. The study authors noted that ILD arises when inflammatory cells activated through immunotherapy damage the healthy lung as well as cancer cells. The findings suggest that individuals with severe inflammation in healthy lungs were more likely to develop ILD after immunotherapy treatment.^1,4

“The results of our study may not only help to predict the occurrence of interstitial lung disease after immunotherapy, but also to elucidate the mechanism of this serious side effect. We should conduct a multicenter prospective study for further investigation,” Yamazaki said in a press release.¹

REFERENCES

1. AI analysis of PET/CT images can predict side effects of immunotherapy in lung cancer. News release. EurekAlert. November 12, 2024. Accessed November 21, 2024. https://www.eurekalert.org/news-releases/1064462

2. American Lung Cancer. Interstitial Lung Disease (ILD). Accessed November 21, 2024. https://www.lung.org/lung-health-diseases/lung-disease-lookup/interstitial-lung-disease

3. Oxford University Press. Management of Lung Cancer in the Patient with Interstitial Lung Disease. November 25, 2022. Accessed November 21, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC9847545/

4. Academic Radiology. F-FDG-PET/CT Uptake by Noncancerous Lung as a Predictor of Interstitial Lung Disease Induced by Immune Checkpoint Inhibitors. September 2, 2024. Accessed November 21, 2024. https://www.academicradiology.org/article/S1076-6332(24)00606-8/abstract