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This review highlights the current applications and future potential of molecular imaging techniques as companion diagnostics during anti-cancer immunotherapy to stratify patients, monitor molecular dynamics, and determine treatment response.

Current regulation of T cell receptor (TCR)-based therapeutics may require repeated testing of patients for specific HLA alleles as well as companion diagnostics development, despite the invariant nature of the HLA genotype and availability of robust clinical HLA tests. This increases the burden on patients and the organizations developing these products. We propose regulatory flexibility to facilitate the development of and access to TCR-based therapeutics.

Immune checkpoint inhibitors are a novel class of cancer treatment that have improved outcomes for a subset of cancer patients. They work by antagonising inhibitory immune pathways, thereby augmenting immune-mediated antitumour responses. However, immune activation is not cancer-specific and often results in the activation of immune cells in non-cancer tissues, resulting in off-target immune-mediated injury and organ dysfunction. Diarrhoea and gastrointestinal tract inflammation are common and sometimes serious side-effects of this type of therapy. Prompt recognition of gastrointestinal toxicity and, in many cases, rapid institution of anti-inflammatory or biologic therapy (or both) is required to reverse these complications. Management of organ-specific complications benefits from multidisciplinary input, including engagement with gastroenterologists for optimal management of immune checkpoint inhibitor-induced enterocolitis. In this British Society of Gastroenterology endorsed guidance document, we have developed a consensus framework for the investigation and management of immune checkpoint inhibitor-induced enterocolitis.

Health-care services are rapidly transforming their organization and workforce in response to the coronavirus disease 2019 (COVID-19) pandemic. These changes, and a desire to mitigate infection risk, are having profound effects on other vital aspects of care, including the care of patients with cancer. Difficult decisions are being made regarding the prioritization of both active treatments and palliative care, despite limited evidence that cancer is an independent risk factor for infection and mortality.

Immune checkpoint inhibitor therapies are a novel group of monoclonal antibodies with proven effectiveness in a wide range of malignancies, including melanoma, renal cell carcinoma, non-small-cell lung cancer, urothelial carcinoma and Hodgkin lymphoma. Their use in a range of other indications, such as gastrointestinal and head and neck cancer, is currently under investigation. The number of agents included in this drug group is increasing, as is their use. Although they have the potential to improve the treatment of advanced malignancies, they are also associated with a substantial risk of immune-related adverse events. The incidence of gastrointestinal toxicity associated with their use is second only in frequency to dermatological toxicity. Thus, gastroenterologists can expect to be increasingly frequently consulted by oncologists as part of a multidisciplinary approach to managing toxicity. Here, we describe this novel group of agents and their mechanisms of action. We review the manifestations of gastrointestinal toxicity associated with their use so that it can be recognized early and diagnosed accurately. We also discuss the proposed mechanisms underlying this toxicity and describe an algorithmic and, wherever possible, evidence-based approach to its management.

Immune checkpoint inhibitors have greatly improved the survival of patients with advanced melanoma and are now becoming standard therapy for treating a wide range of different forms of cancer. Although immune mediated neurological complications related to these drugs are reported to be uncommon, occurring in around 1% patients, with the increased use of these treatments, there are likely to be more cases of neurotoxicity recognised in patients receiving cancer immunotherapy.We present a case series of 6 patients, seen in our trust, who developed a range of neurological complications associated with immune checkpoint inhibitor use. The conditions we encountered were:Myasthenia gravis, autoimmune encephalitis, aseptic meningitis and hypophysitis in 4 patients diagnosed with advanced melanoma treated with both single and combined immunotherapyCerebellar ataxia, that re-occurred with each immunotherapy treatment for oesophageal cancerWorsening of migraine with the commencement of treatment for bladder cancerThese cases illustrate the diverse adverse effects that these drugs can have on both the peripheral and central nervous system and the sometimes complex management required to treat them. We discuss the guidelines for treatment of immune checkpoint inhibitor neurotoxicity and the importance of recognising these conditions.

COVID-19 has forced governments to make drastic changes to healthcare systems. To start making informed decisions about cancer care, we need to understand the scale of COVID-19 infection. Therefore, we introduced swab testing for patients visiting Guy’s Cancer Centre. Our Centre is one of the largest UK Cancer Centers at the epicenter of the UK COVID-19 epidemic. The first COVID-19 positive cancer patient was reported on 29 February 2020. We analyzed data from 7-15 May 2020 for COVID-19 tests in our cancer patients. 2,647 patients attended for outpatient, chemotherapy, or radiotherapy appointments. 654 were swabbed for COVID-19 (25%). Of those tested, 9 were positive for COVID-19 (1.38%) of which 7 were asymptomatic. Cancer service providers will need to understand their local cancer population prevalence. The absolute priority is that cancer patients have the confidence to attend hospitals and be reassured that they will be treated in a COVID-19 managed environment.

Chimeric antigen receptors (CARs) are fusion molecules that re-direct T-cell specificity against a selected cell surface target. Recent successes in the treatment of haematological malignancies using CD19-specific CAR T cells has moved this approach into the clinical mainstream. On target, off tumour toxicity, inadequate homing, and limited survival of CAR T cells are important challenges to the adaptation of this promising technology to treat solid tumours. We aimed to address these limitations while developing a clinically applicable T-cell immunotherapy for the commonest male malignancy, prostate cancer. Targeting has been directed against prostate-specific membrane antigen (PSMA), a cell-surface glycoprotein that is overexpressed by more than 80% of cases, with highest levels in castration-resistant disease