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Gregory J. Riely, MD, PhD


Immune Checkpoint Inhibitors and Lung Cancer: Tumor Vasculature–Based Imaging Biomarker

By: Joshua D. Madera, MS
Posted: Tuesday, March 7, 2023

For patients with non–small cell lung cancer (NSCLC), responsiveness to immunotherapy may be determined using the artificial intelligence (AI)-based biomarker quantitative vessel tortuosity (QVT), according to a study published in Science Advances. Through routine imaging, this biomarker may assist with treatment strategies and may ultimately reduce an unnecessary financial burden placed on patients who may likely be unresponsive to immunotherapy, explained Mohammadhadi Khorrami, PhD, of Emory University, Atlanta, and colleagues.

“The ability to predict response to immunotherapy merely from a baseline CT scan would be a game-changer because if we find out which patients will and will not respond to therapy, we can offer different therapeutic modalities,” commented Dr. Khorrami in an Emory press release. “Moreover, with the staggering costs of immunotherapy—around $200,000 a year per patient—the need to noninvasively determine this response before initiating therapy becomes crucial.”

A total of 507 patients with NSCLC were recruited for the study. All patients received baseline and post-treatment imaging to measure any changes in QVT. A total of 162 patients were stratified into four subtreatment groups (groups 1–4) and were either treated with immune checkpoint inhibitors alone or immune checkpoint inhibitors with chemotherapy. PD-L1 expression (n = 204) and tumor-infiltrating lymphocyte (TIL) density (n = 32) were also measured to assess the role of QVT in biochemical pathways.

The study findings revealed several QVT features associated with patient overall survival, including the QVT risk score (hazard ratio [HR] = 2.49 in group 2, 2.12 in group 3, and 2.98 in group 4). In addition, a positive association was identified between the QVT risk score and PD-L1 expression with overall survival (HR = 2.17). Furthermore, patients who responded to immunotherapy had fewer tortuous vessel branches compared with nonresponders. This was further supported by a reduction in acute angles observed in responders compared with nonresponders.

Disclosure: For full disclosures of the study authors, visit

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