The anticancer drugs have evolved significantly, spanning molecular targeted therapeutics (MTTs), immune checkpoint inhibitors (ICIs), chimeric antigen receptor T-cell (CAR-T) therapy, and antibody-drug conjugates (ADCs). Complications associated with these drugs vary widely based on their mechanisms of action. MTTs that target angiogenesis can often lead to complications related to ischemia or endothelial damage across various organs, whereas non-anti-angiogenic MTTs present unique complications derived from their specific pharmacological actions. ICIs are predominantly associated with immunerelated adverse events, such as pneumonitis, colitis, hepatitis, thyroid disorders, hypophysitis, and sarcoid-like reactions. CAR-T therapy causes unique and severe complications including cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. ADCs tend to cause complications associated with cytotoxic payloads. A comprehensive understanding of these drug-specific toxicities, particularly using medical imaging, is essential for providing optimal patient care. Based on this knowledge, radiologists can play a pivotal role in multidisciplinary teams. Therefore, radiologists must stay up-to-date on the imaging characteristics of these complications and the mechanisms underlying novel anticancer drugs.

Clinical trials for chimeric antigen receptor (CAR) T-cell therapy are in the early stages but are expected to progress alongside new treatment approaches. This suggests that imaging will play an important role in monitoring disease progression, treatment response, and treatment-related side effects. There are, however, challenges that remain unresolved, regarding imaging in CAR T-cell therapy. We herein discuss the role of imaging, focusing on how tumor response evaluation varies according to cancer type and target antigens in CAR T-cell therapy. CAR T-cell therapy often produces rapid and significant responses, and imaging is vital for identifying side effects such as cytokine release syndrome and neurotoxicity. Radiologists should be aware of drug mechanisms, response assessments, and associated toxicities to effectively support these therapies. Additionally, this article highlights the importance of the Lugano criteria, which is essential for standardized assessment of treatment response, particularly in lymphoma therapies, and also explores other factors influencing imaging-based evaluation, including emerging methodologies and their potential to improve the accuracy and consistency of response assessments.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) represents a devastating and growing global threat, calling for new antibiotic treatments. In Korea, the challenge of treating CRAB is compounded by high nosocomial acquisition rates and limited availability of novel antibiotics. Minocycline, a semisynthetic tetracycline derivative, has been proposed as a therapeutic option for CRAB infections. Nonsusceptibility to minocycline may occur through the efflux pump, TetB. The prevalence of tetB in A. baumannii has increased, along with higher minocycline minimum inhibitory concentrations (MICs). We aimed to evaluate minocycline susceptibility rates in clinical strains of CRAB, and the association between tetB carriage and minocycline susceptibility across different genotypes. Materials and Methods: Representative CRAB blood isolates were collected from Asan Medical Center, Seoul.Minocycline susceptibility was assessed using the Clinical and Laboratory Standards Institute (CLSI) breakpoint (≤4 mg/L) and the proposed pharmacokinetics (PK)/pharmacodynamics (PD) breakpoint (≤1 mg/L). Tigecycline was used as a comparator, and its susceptibility breakpoint for Enterobacterales defined by EUCAST was applied (≤0.5 mg/L).The presence of tetB was detected by PCR, and multilocus sequence typing (MLST) was performed using seven housekeeping genes. Results: Of the 160 CRAB blood isolates, 83.8% were susceptible to minocycline by the CLSI criteria, and 50.6% were PK-PD susceptible by the PK-PD criteria. The minocycline minimum inhibitory concentration (MIC)50 /MIC90 was 1/8 mg/L. tetB was present in 49% of isolates and was associated with a higher minocycline MIC (MIC50/90 2/8 mg/L vs. 1/2 mg/L). No clear correlation was observed between tetB positivity and tigecycline MIC. Nine MLSTs were identified, with significant differences in tetB carriage rates between the major sequence types. Notably, ST191, associated with non-tetB carriage and greater susceptibility to minocycline, declined over the study period (P=0.004), while ST451, associated with tetB carriage, increased. Conclusion tetB was present in 49% of CRAB isolates and was associated with higher MICs and non-susceptibility by both CLSI and PK-PD criteria. However, absence of tetB was not a reliable predictor of minocycline PK-PD susceptibility. Additionally, shifts over time towards genotypes with reduced minocycline susceptibility were observed. Further research is needed to correlate these findings with clinical outcomes and identify additional resistance mechanisms.

The anticancer drugs have evolved significantly, spanning molecular targeted therapeutics (MTTs), immune checkpoint inhibitors (ICIs), chimeric antigen receptor T-cell (CAR-T) therapy, and antibody-drug conjugates (ADCs). Complications associated with these drugs vary widely based on their mechanisms of action. MTTs that target angiogenesis can often lead to complications related to ischemia or endothelial damage across various organs, whereas non-anti-angiogenic MTTs present unique complications derived from their specific pharmacological actions. ICIs are predominantly associated with immunerelated adverse events, such as pneumonitis, colitis, hepatitis, thyroid disorders, hypophysitis, and sarcoid-like reactions. CAR-T therapy causes unique and severe complications including cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. ADCs tend to cause complications associated with cytotoxic payloads. A comprehensive understanding of these drug-specific toxicities, particularly using medical imaging, is essential for providing optimal patient care. Based on this knowledge, radiologists can play a pivotal role in multidisciplinary teams. Therefore, radiologists must stay up-to-date on the imaging characteristics of these complications and the mechanisms underlying novel anticancer drugs.

Clinical trials for chimeric antigen receptor (CAR) T-cell therapy are in the early stages but are expected to progress alongside new treatment approaches. This suggests that imaging will play an important role in monitoring disease progression, treatment response, and treatment-related side effects. There are, however, challenges that remain unresolved, regarding imaging in CAR T-cell therapy. We herein discuss the role of imaging, focusing on how tumor response evaluation varies according to cancer type and target antigens in CAR T-cell therapy. CAR T-cell therapy often produces rapid and significant responses, and imaging is vital for identifying side effects such as cytokine release syndrome and neurotoxicity. Radiologists should be aware of drug mechanisms, response assessments, and associated toxicities to effectively support these therapies. Additionally, this article highlights the importance of the Lugano criteria, which is essential for standardized assessment of treatment response, particularly in lymphoma therapies, and also explores other factors influencing imaging-based evaluation, including emerging methodologies and their potential to improve the accuracy and consistency of response assessments.

The anticancer drugs have evolved significantly, spanning molecular targeted therapeutics (MTTs), immune checkpoint inhibitors (ICIs), chimeric antigen receptor T-cell (CAR-T) therapy, and antibody-drug conjugates (ADCs). Complications associated with these drugs vary widely based on their mechanisms of action. MTTs that target angiogenesis can often lead to complications related to ischemia or endothelial damage across various organs, whereas non-anti-angiogenic MTTs present unique complications derived from their specific pharmacological actions. ICIs are predominantly associated with immunerelated adverse events, such as pneumonitis, colitis, hepatitis, thyroid disorders, hypophysitis, and sarcoid-like reactions. CAR-T therapy causes unique and severe complications including cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. ADCs tend to cause complications associated with cytotoxic payloads. A comprehensive understanding of these drug-specific toxicities, particularly using medical imaging, is essential for providing optimal patient care. Based on this knowledge, radiologists can play a pivotal role in multidisciplinary teams. Therefore, radiologists must stay up-to-date on the imaging characteristics of these complications and the mechanisms underlying novel anticancer drugs.

Clinical trials for chimeric antigen receptor (CAR) T-cell therapy are in the early stages but are expected to progress alongside new treatment approaches. This suggests that imaging will play an important role in monitoring disease progression, treatment response, and treatment-related side effects. There are, however, challenges that remain unresolved, regarding imaging in CAR T-cell therapy. We herein discuss the role of imaging, focusing on how tumor response evaluation varies according to cancer type and target antigens in CAR T-cell therapy. CAR T-cell therapy often produces rapid and significant responses, and imaging is vital for identifying side effects such as cytokine release syndrome and neurotoxicity. Radiologists should be aware of drug mechanisms, response assessments, and associated toxicities to effectively support these therapies. Additionally, this article highlights the importance of the Lugano criteria, which is essential for standardized assessment of treatment response, particularly in lymphoma therapies, and also explores other factors influencing imaging-based evaluation, including emerging methodologies and their potential to improve the accuracy and consistency of response assessments.