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Bleckman RF, Haag CMSC, Rifaela N, Beukema G, Mathijssen RHJ, Steeghs N, Gelderblom H, Desar IME, Cleven A, Ter Elst A, Schuuring E, Reyners AKL. Levels of circulating tumor DNA correlate with tumor volume in gastro-intestinal stromal tumors: an exploratory long-term follow-up study. Mol Oncol 2024. [PMID: 38790141 DOI: 10.1002/1878-0261.13644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 05/26/2024] Open
Abstract
Patients with gastro-intestinal stromal tumors (GISTs) undergoing tyrosine kinase inhibitor therapy are monitored with regular computed tomography (CT) scans, exposing patients to cumulative radiation. This exploratory study aimed to evaluate circulating tumor DNA (ctDNA) testing to monitor treatment response and compare changes in ctDNA levels with RECIST 1.1 and total tumor volume measurements. Between 2014 and 2021, six patients with KIT proto-oncogene, receptor tyrosine kinase (KIT) exon-11-mutated GIST from whom long-term plasma samples were collected prospectively were included in the study. ctDNA levels of relevant plasma samples were determined using the KIT exon 11 digital droplet PCR drop-off assay. Tumor volume measurements were performed using a semi-automated approach. In total, 94 of 130 clinically relevant ctDNA samples were analyzed. Upon successful treatment response, ctDNA became undetectable in all patients. At progressive disease, ctDNA was detectable in five out of six patients. Higher levels of ctDNA correlated with larger tumor volumes. Undetectable ctDNA at the time of progressive disease on imaging was consistent with lower tumor volumes compared to those with detectable ctDNA. In summary, ctDNA levels seem to correlate with total tumor volume at the time of progressive disease. Our exploratory study shows promise for including ctDNA testing in treatment follow-up.
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Affiliation(s)
- Roos F Bleckman
- Department of Medical Oncology and Pathology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Charlotte M S C Haag
- Department of Medical Oncology and Pathology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Naomi Rifaela
- Department of Medical Oncology and Pathology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Gerrieke Beukema
- Department of Medical Oncology and Pathology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arjen Cleven
- Department of Medical Oncology and Pathology, University Medical Center Groningen, University of Groningen, The Netherlands
- Department of Medical Oncology, Leiden University Medical Center, The Netherlands
| | - Arja Ter Elst
- Department of Medical Oncology and Pathology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Ed Schuuring
- Department of Medical Oncology and Pathology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology and Pathology, University Medical Center Groningen, University of Groningen, The Netherlands
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2
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Gong AJ, Ruchalski K, Kim HJ, Douek M, Gutierrez A, Patel M, Sai V, Coy H, Villegas B, Raman S, Goldin J. RECIST 1.1 Target Lesion Categorical Response in Metastatic Renal Cell Carcinoma: A Comparison of Conventional versus Volumetric Assessment. Radiol Imaging Cancer 2023; 5:e220166. [PMID: 37656041 PMCID: PMC10546365 DOI: 10.1148/rycan.220166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
Purpose To investigate Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) approximations of target lesion tumor burden by comparing categorical treatment response according to conventional RECIST versus actual tumor volume measurements of RECIST target lesions. Materials and Methods This is a retrospective cohort study of individuals with metastatic renal cell carcinoma enrolled in a clinical trial (from 2003 to 2017) and includes individuals who underwent baseline and at least one follow-up chest, abdominal, and pelvic CT study and with at least one target lesion. Target lesion volume was assessed by (a) Vmodel, a spherical model of conventional RECIST 1.1, which was extrapolated from RECIST diameter, and (b) Vactual, manually contoured volume. Volumetric responses were determined by the sum of target lesion volumes (Vmodel-sum TL and Vactual-sum TL, respectively). Categorical volumetric thresholds were extrapolated from RECIST. McNemar tests were used to compare categorical volume responses. Results Target lesions were assessed at baseline (638 participants), week 9 (593 participants), and week 17 (508 participants). Vmodel-sum TL classified more participants as having progressive disease (PD), compared with Vactual-sum TL at week 9 (52 vs 31 participants) and week 17 (57 vs 39 participants), with significant overall response discordance (P < .001). At week 9, 25 (48%) of 52 participants labeled with PD by Vmodel-sum TL were classified as having stable disease by Vactual-sum TL. Conclusion A model of RECIST 1.1 based on a single diameter measurement more frequently classified PD compared with response assessment by actual measured tumor volume. Keywords: Urinary, Kidney, Metastases, Oncology, Tumor Response, Volume Analysis, Outcomes Analysis ClinicalTrials.gov registration no. NCT01865747 © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Amanda J. Gong
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Kathleen Ruchalski
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Hyun J. Kim
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Michael Douek
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Antonio Gutierrez
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Maitraya Patel
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Victor Sai
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Heidi Coy
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Bianca Villegas
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Steven Raman
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Jonathan Goldin
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
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3
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He LN, Fu S, Ma H, Chen C, Zhang X, Li H, Du W, Chen T, Jiang Y, Wang Y, Wang Y, Zhou Y, Lin Z, Yang Y, Huang Y, Zhao H, Fang W, Zhang H, Zhang L, Hong S. Early on-treatment tumor growth rate (EOT-TGR) determines treatment outcomes of advanced non-small-cell lung cancer patients treated with programmed cell death protein 1 axis inhibitor. ESMO Open 2022; 7:100630. [PMID: 36442353 PMCID: PMC9808481 DOI: 10.1016/j.esmoop.2022.100630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/02/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Tumor growth rate (TGR), denoted as percentage change in tumor size per month, is a well-established indicator of tumor growth kinetics. The predictive value of early on-treatment TGR (EOT-TGR) for immunotherapy remains unclear. We sought to establish and validate the association of EOT-TGR with treatment outcomes in patients with advanced non-small-cell lung cancer (aNSCLC) undergoing anti-PD-1/PD-L1 (programmed cell death protein 1/programmed death-ligand 1) therapy. PATIENTS AND METHODS This bicenter retrospective cohort study included a training cohort, a contemporaneously treated internal validation cohort, and an external validation cohort. Computed tomography images were retrieved to calculate EOT-TGR, denoted as tumor burden change per month during a period between baseline and the first imaging evaluation after immunotherapy. Kaplan-Meier methodology and Cox regression analysis were conducted for survival analyses. RESULTS In the pooled cohort (n = 172), 125 patients (72.7%) were males; median age at diagnosis was 58 (range 28-79) years. Based on the training cohort, we determined the optimal cut-off value for EOT-TGR as 10.4%/month. Higher EOT-TGR was significantly associated with inferior overall survival [OS; hazard ratio (HR) 2.93, 95% confidence interval (CI) 1.47-5.83; P = 0.002], worse progression-free survival (PFS; HR 2.44, 95% CI 1.46-4.08; P = 0.001), and lower objective response rate (3.3% versus 20.9%; P = 0.040) and durable clinical benefit rate (6.7% versus 41.9%; P = 0.001). Results were reproducible in the two validation cohorts for OS and PFS. Among 43 patients who had a best response of progressive disease in the training cohort, those with high EOT-TGR had worse OS (HR 2.64; P = 0.041) and were more likely to progress due to target lesions at the first tumor evaluation (85.2% versus 0.0%; P <0.001). CONCLUSIONS Higher EOT-TGR was associated with inferior OS and immunotherapeutic response in patients with aNSCLC undergoing anti-PD-1/PD-L1 therapy. This easy-to-calculate radiologic biomarker may help evaluate the abilities of immunotherapy to prolong survival and assist in tailoring patients' management. TRIAL REGISTRATION ClinicalTrials.govNCT04722406; https://clinicaltrials.gov/ct2/show/NCT04722406.
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Affiliation(s)
- L.-N. He
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - S. Fu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation of Sun Yat-Sen University; Department of Cellular & Molecular Diagnostics Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - H. Ma
- Department of Oncology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China
| | - C. Chen
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Departments of Radiation Oncology, Guangzhou, China
| | - X. Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - H. Li
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - W. Du
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - T. Chen
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Nuclear Medicine, Guangzhou, China
| | - Y. Jiang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Nuclear Medicine, Guangzhou, China
| | - Y. Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Y. Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Endoscopy, Guangzhou, China
| | - Y. Zhou
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,VIP Region, Guangzhou, China
| | - Z. Lin
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Y. Yang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Y. Huang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - H. Zhao
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - W. Fang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - H. Zhang
- Department of Oncology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China,Prof. Haibo Zhang, Department of Oncology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Guangzhou, Guangdong 510120, People’s Republic of China. Tel: +86-20-81887233-34830
| | - L. Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China,Prof. Li Zhang, MD, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong 510060, People’s Republic of China. Tel: +86-20-87343458
| | - S. Hong
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China,Correspondence to: Prof. Shaodong Hong, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong 510060, People’s Republic of China. Tel: +86-20-87342480
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4
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Kyriazoglou A, Jespers P, Vandecavaye V, Mir O, Kasper B, Papai Z, Blay JY, Italiano A, Zaffaroni F, Litière S, Nzokirantevye A, Schöffski P. Exploratory analysis of tumor imaging in a Phase 2 trial with cabozantinib in gastrointestinal stromal tumor: lessons learned from study EORTC STBSG 1317 'CaboGIST'. Acta Oncol 2022; 61:663-668. [PMID: 35481400 DOI: 10.1080/0284186x.2022.2068967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are malignant mesenchymal tumors arising in the gastrointestinal tract. Their systemic treatment is based on the use of tyrosine kinase inhibitors (TKIs) with imatinib, sunitinib, and regorafenib being the preferred agents. Assessment of tumor response to TKI treatment in GISTs is traditionally done according the Response Evaluation Criteria in Solid Tumors (RECIST), while Choi criteria have also been proposed as alternative tool assessing both volumetric and density changes on computer tomography (CT) scans. EORTC STBSG 1317 'CaboGIST' was a single-arm prospective Phase 2 trial which met its primary endpoint, as 60% of patients previously treated with imatinib and sunitinib were progression-free at 12 weeks (95% CI 45-74%) based on local RECIST assessment. MATERIALS AND METHODS We report here an exploratory analysis of local versus central RECIST version 1.1 assessment and a comparison of RECIST version 1.1 versus Choi criteria. RESULTS Comparisons between local and central RECIST version 1.1 at week 12 revealed discrepancies in 17/43 evaluable cases (39.5%). When comparing Choi with local and central RECIST version 1.1, discrepancies were observed in 27/43 (62.8%) and 21/43 (48.8%) cases, respectively. A total of 68% of evaluable patients were progression-free and alive at week 12 based on local RECIST, 84% according to central RECIST analysis and 81% when applying Choi criteria. Central assessment upgraded the treatment response both with RECIST version 1.1 and Choi. CONCLUSIONS The results of this exploratory analysis support the conclusion that cabozantinib is active in patients with metastatic or recurrent GIST after treatment with imatinib and sunitinib and confirm once again the limitations of RECIST to capture response to TKI in GIST, and the importance to include density changes in the response evaluation in this setting. Clinical trial number: EORTC 1317, NCT02216578.
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Affiliation(s)
- Anastasios Kyriazoglou
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
- Second Propaedeutic Department of Medicine, Attikon University Hospital, Athens, Greece
| | - Pieter Jespers
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Vincent Vandecavaye
- Department of Radiology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Mir
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Bernd Kasper
- Mannheim University Medical Center, Mannheim Cancer Center (MCC), University of Heidelberg, Mannheim, Germany
| | | | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | | | - Facundo Zaffaroni
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Saskia Litière
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | | | - Patrick Schöffski
- Second Propaedeutic Department of Medicine, Attikon University Hospital, Athens, Greece
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5
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Wesdorp NJ, Bolhuis K, Roor J, van Waesberghe JHTM, van Dieren S, van Amerongen MJ, Chapelle T, Dejong CHC, Engelbrecht MRW, Gerhards MF, Grunhagen D, van Gulik TM, Hermans JJ, de Jong KP, Klaase JM, Liem MSL, van Lienden KP, Molenaar IQ, Patijn GA, Rijken AM, Ruers TM, Verhoef C, de Wilt JHW, Swijnenburg RJ, Punt CJA, Huiskens J, Kazemier G. The Prognostic Value of Total Tumor Volume Response Compared With RECIST1.1 in Patients With Initially Unresectable Colorectal Liver Metastases Undergoing Systemic Treatment. ANNALS OF SURGERY OPEN 2021; 2:e103. [PMID: 37637880 PMCID: PMC10455281 DOI: 10.1097/as9.0000000000000103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/17/2021] [Indexed: 01/20/2023] Open
Abstract
Objectives Compare total tumor volume (TTV) response after systemic treatment to Response Evaluation Criteria in Solid Tumors (RECIST1.1) and assess the prognostic value of TTV change and RECIST1.1 for recurrence-free survival (RFS) in patients with colorectal liver-only metastases (CRLM). Background RECIST1.1 provides unidimensional criteria to evaluate tumor response to systemic therapy. Those criteria are accepted worldwide but are limited by interobserver variability and ignore potentially valuable information about TTV. Methods Patients with initially unresectable CRLM receiving systemic treatment from the randomized, controlled CAIRO5 trial (NCT02162563) were included. TTV response was assessed using software specifically developed together with SAS analytics. Baseline and follow-up computed tomography (CT) scans were used to calculate RECIST1.1 and TTV response to systemic therapy. Different thresholds (10%, 20%, 40%) were used to define response of TTV as no standard currently exists. RFS was assessed in a subgroup of patients with secondarily resectable CRLM after induction treatment. Results A total of 420 CT scans comprising 7820 CRLM in 210 patients were evaluated. In 30% to 50% (depending on chosen TTV threshold) of patients, discordance was observed between RECIST1.1 and TTV change. A TTV decrease of >40% was observed in 47 (22%) patients who had stable disease according to RECIST1.1. In 118 patients with secondarily resectable CRLM, RFS was shorter for patients with less than 10% TTV decrease compared with patients with more than 10% TTV decrease (P = 0.015), while RECIST1.1 was not prognostic (P = 0.821). Conclusions TTV response assessment shows prognostic potential in the evaluation of systemic therapy response in patients with CRLM.
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Affiliation(s)
- Nina J. Wesdorp
- From the Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karen Bolhuis
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joran Roor
- Department of Health, SAS Institute B.V., Huizen, The Netherlands
| | - Jan-Hein T. M. van Waesberghe
- Department of Radiology and Molecular Imaging, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Susan van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin J. van Amerongen
- Department of Medical Imaging, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Thiery Chapelle
- Department of Hepatobiliary, Transplantation, and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Cornelis H. C. Dejong
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Universitätsklinikum Aachen, Aachen, Germany
| | - Marc R. W. Engelbrecht
- Department of Radiology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael F. Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands
| | - Dirk Grunhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Thomas M. van Gulik
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - John J. Hermans
- Department of Medical Imaging, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Koert P. de Jong
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost M. Klaase
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mike S. L. Liem
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Krijn P. van Lienden
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - I. Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht and St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gijs A. Patijn
- Department of Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Arjen M. Rijken
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - Theo M. Ruers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Johannes H. W. de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J. A. Punt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost Huiskens
- Department of Health, SAS Institute B.V., Huizen, The Netherlands
| | - Geert Kazemier
- From the Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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6
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Revheim ME, Hole KH, Mo T, Bruland ØS, Reitan E, Julsrud L, Seierstad T. Multimodal functional imaging for early response assessment in patients with gastrointestinal stromal tumor treated with tyrosine kinase inhibitors. Acta Radiol 2021; 63:995-1004. [PMID: 34171968 DOI: 10.1177/02841851211027389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several imaging modalities are used in the early work-up of patients with gastrointestinal stromal tumor (GIST) receiving tyrosine kinase inhibitor (TKI) treatment and there is a need to establish whether they provide similar or complimentary information. PURPOSE To compare 18F-fluorodeoxyglucose positron emission tomography (FDG PET), computed tomography (CT) and magnetic resonance imaging (MRI) as early predictors of three-month outcomes for patients with GIST receiving TKI treatment. MATERIAL AND METHODS Thirty-five patients with advanced GIST were prospectively included between February 2011 and June 2017. FDG PET, contrast-enhanced CT (CECT), and MRI were performed before and early after onset of TKI treatment (range 8-18 days). Early response was categorized according to mRECIST (CT), the Choi criteria (CECT), and PERCIST (FDG PET/CT). For MRI, volumetry from T2-weighted images and change in apparent diffusion coefficient (ADC) from diffusion-weighted imaging was used. The reference standard for early assessment was the three-month mRECIST evaluation based on CT. At three months, both stable disease (SD) and partial response (PR) were categorized as response. Clinical usefulness was defined as agreement between early and three-month assessment. RESULTS At the three-month assessment, 91% (32/35) were responders, 37% (13/35) PR, 54% (19/35) SD, and 9% (3/35) had progressive disease (PD). Early assessment correctly predicted three-month response in 93% (27/29) for MRI, 80% (28/35) for PERCIST, 74% (26/35) for Choi, and 23% (8/35) for mRECIST. Six patients had non-FDG-avid tumors. For the FDG-avid tumors, PET/CT correctly predicted three-month response in 97% (28/29). CONCLUSION MRI was superior to CECT for early assessment of TKI-treatment response in GIST. If the tumor was FDG-avid, PET and MRI were equally good. Changes in functional parameters were superior to changes in longest tumor diameter (mRECIST).
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Affiliation(s)
- Mona-Elisabeth Revheim
- Department of Nuclear Medicine, Division for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo University Hospital, Oslo, Norway
- Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Håkon Hole
- Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncologic Radiology, Division for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Torgeir Mo
- Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øyvind S Bruland
- Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo University Hospital, Oslo, Norway
| | - Edmund Reitan
- Department of Oncologic Radiology, Division for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Lars Julsrud
- Department of Oncologic Radiology, Division for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Therese Seierstad
- Department for Research and Development, Division for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo University Hospital, Oslo, Norway
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7
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Tan JW, Wang L, Chen Y, Xi W, Ji J, Wang L, Xu X, Zou LK, Feng JX, Zhang J, Zhang H. Predicting Chemotherapeutic Response for Far-advanced Gastric Cancer by Radiomics with Deep Learning Semi-automatic Segmentation. J Cancer 2020; 11:7224-7236. [PMID: 33193886 PMCID: PMC7646171 DOI: 10.7150/jca.46704] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/04/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose: To build a dual-energy computed tomography (DECT) delta radiomics model to predict chemotherapeutic response for far-advanced gastric cancer (GC) patients. A semi-automatic segmentation method based on deep learning was designed, and its performance was compared with that of manual segmentation. Methods: This retrospective study included 86 patients with far-advanced GC treated with chemotherapy from September 2016 to December 2017 (66 and 20 in the training and testing cohorts, respectively). Delta radiomics features between the baseline and first follow-up DECT were modeled by random forest to predict the chemotherapeutic response evaluated by the second follow-up DECT. Nine feature subsets from confounding factors and delta radiomics features were used to choose the best model with 10-fold cross-validation in the training cohort. A semi-automatic segmentation method based on deep learning was developed to predict the chemotherapeutic response and compared with manual segmentation in the testing cohort, which was further validated in an independent validation cohort of 30 patients. Results: The best model, constructed by confounding factors and texture features, reached an average AUC of 0.752 in the training cohort. Our proposed semi-automatic segmentation method was more time-effective than manual segmentation, with average saving-time of 11.2333 ± 6.3989 minutes and 9.9889 ±5.5086 minutes in the testing cohort and the independent validation cohort, respectively (both p < 0.05). The predictive ability of the semi-automatic segmentation was also better than that of the manual segmentation both in the testing cohort and the independent validation cohort (AUC: 0.728 vs. 0.687 and 0.828 vs. 0.749, respectively). Conclusion: DECT delta radiomics serves as a promising biomarker for predicting chemotherapeutic response for far-advanced GC. Semi-automatic segmentation based on deep learning shows the potential for clinical use with increased reproducibility and decreased labor costs compared to the manual version.
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Affiliation(s)
- Jing-Wen Tan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - WenQi Xi
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Ji
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingyun Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Xu
- Haohua Technology Co., Ltd, Weihai International Group Building, No. 511 Weihai Road, Shanghai, China
| | - Long-Kuan Zou
- Haohua Technology Co., Ltd, Weihai International Group Building, No. 511 Weihai Road, Shanghai, China
| | - Jian-Xing Feng
- Haohua Technology Co., Ltd, Weihai International Group Building, No. 511 Weihai Road, Shanghai, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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8
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Arshad J, Ahmed J, Subhawong T, Trent JC. Progress in determining response to treatment in gastrointestinal stromal tumor. Expert Rev Anticancer Ther 2020; 20:279-288. [PMID: 32191549 DOI: 10.1080/14737140.2020.1745068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Gastrointestinal stromal tumor (GIST) is the most common malignant mesenchymal tumor of the gastrointestinal system. Multiple advances in the management of GIST from the discovery of KIT/PDGRA and other genetic alterations have led to the development of multiple tyrosine kinase inhibitors. Response assessment in GIST is determined with iRECIST (Response Evaluation Criteria in Solid Tumors), PERCIST (PET response criteria in solid tumors), or Choi criteria. Molecular genotyping of the tissue samples is the recent standard for diagnosis, treatment, and response to treatment.Areas covered: In this study, we provide a brief overview of the history of the GIST, molecular sequencing, available treatment options and clinical trials, radiologic response assessment, and the role of ctDNA in response evaluation.Expert opinion: Future GIST management is related to the development of sensitive assays to detect genetic alterations for initial diagnosis, treatment selection, monitoring the response to treatment, resistant mutations, and predicting survival.
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Affiliation(s)
- Junaid Arshad
- Miller School of Medicine/Sylvester Comprehensive Cancer Centre, University of Miami, Miami, FL, USA
| | - Jibran Ahmed
- Department of Hematology and Medical Oncology, Westchester Medical Center, Valhalla, NY, USA
| | - Ty Subhawong
- Miller School of Medicine/Sylvester Comprehensive Cancer Centre, University of Miami, Miami, FL, USA
| | - Jonathan C Trent
- Miller School of Medicine/Sylvester Comprehensive Cancer Centre, University of Miami, Miami, FL, USA
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9
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Ten Berge DMHJ, Hurkmans DP, den Besten I, Kloover JS, Mathijssen RHJ, Debets R, Smit EF, Aerts JGJV. Tumour growth rate as a tool for response evaluation during PD-1 treatment for non-small cell lung cancer: a retrospective analysis. ERJ Open Res 2019; 5:00179-2019. [PMID: 31857994 PMCID: PMC6911925 DOI: 10.1183/23120541.00179-2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/03/2019] [Indexed: 12/25/2022] Open
Abstract
Background Immune checkpoint inhibitors have emerged as a standard of care treatment for non-small cell lung cancer (NSCLC). To get insight into variations in tumour growth kinetics and their potential predictive values for outcome, we evaluated tumour growth rate (TGR) in patients receiving programmed cell death 1 (PD-1) checkpoint inhibitors. Patients and methods Differences in TGR before and after the start of treatment were calculated by entering the sum of the longest diameters from computer tomography scans before and after the initiation of therapy into a formula that assumes volumetric exponential tumour growth. TGR variations, possible predictors for TGR changes and its relationship to overall survival (OS) were studied. For comparison, tumour response was assessed using Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. Results Among the 58 evaluable patients, 37 patients (64%) showed deceleration of TGR and 16 patients (27%) showed an acceleration of TGR after initiation of therapy, with a significant difference in median OS of 18.0 months versus 6.0 months (hazard ratio 0.35, 95% CI 0.18–0.71) between these groups. Four patients (7%) were defined as having hyperprogressive disease. In five patients (9%), tumour growth remained stable. These TGR categories were not significantly different according to age, sex, histology, smoking or previous radiotherapy. Of the patients defined as having progressive disease by RECIST version 1.1 at first follow-up, 40% showed response to checkpoint inhibitors by a decrease in TGR. Conclusion Tumour growth kinetics can be used as a clinically relevant predictor for OS in anti-PD-1-treated patients with NSCLC, and may provide additional information to RECIST measurements. Tumour growth rate changes can be used as a clinically relevant predictor of overall survival during PD-1 inhibitor therapy for NSCLC and provide additional information to RECIST measurements alonehttp://bit.ly/2nxT17e
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Affiliation(s)
- Deirdre M H J Ten Berge
- Dept of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.,Dept of Pulmonary Diseases, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Daniel P Hurkmans
- Dept of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Dept of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ilse den Besten
- Dept of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jeroen S Kloover
- Dept of Pulmonary Diseases, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Ron H J Mathijssen
- Dept of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Reno Debets
- Dept of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Egbert F Smit
- Netherlands Cancer Institute, Amsterdam, The Netherlands.,These authors contributed equally
| | - Joachim G J V Aerts
- Dept of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Dept of Pulmonary Medicine, Amphia Hospital, Breda, The Netherlands.,These authors contributed equally
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10
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Schindler E, Krishnan SM, Mathijssen R, Ruggiero A, Schiavon G, Friberg LE. Pharmacometric Modeling of Liver Metastases' Diameter, Volume, and Density and Their Relation to Clinical Outcome in Imatinib-Treated Patients With Gastrointestinal Stromal Tumors. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2017; 6:449-457. [PMID: 28379635 PMCID: PMC5529749 DOI: 10.1002/psp4.12195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/28/2017] [Accepted: 03/22/2017] [Indexed: 12/12/2022]
Abstract
Three‐dimensional and density‐based tumor metrics have been suggested to better discriminate tumor response to treatment than unidimensional metrics, particularly for tumors exhibiting nonuniform size changes. In the developed pharmacometric modeling framework based on data from 77 imatinib‐treated gastrointestinal patients, the time‐courses of liver metastases' maximum transaxial diameters, software‐calculated actual volumes (Vactual) and calculated ellipsoidal volumes were characterized by logistic growth models, in which imatinib induced a linear dose‐dependent size reduction. An indirect response model best described the reduction in density. Substantial interindividual variability in the drug effect of all response assessments and additional interlesion variability in the drug effect on density were identified. The predictive ability of longitudinal tumor unidimensional and three‐dimensional size and density on overall survival (OS) and progression‐free survival (PFS) were compared using parametric time‐to‐event models. Death hazard increased with increasing Vactual. This framework may guide early clinical interventions based on three‐dimensional tumor responses to enhance benefits for patients with gastrointestinal stromal tumors (GIST).
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Affiliation(s)
- E Schindler
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - S M Krishnan
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Rhj Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - A Ruggiero
- Department of Radiology, Papworth Hospital NHS Foundation Trust, Cambridge University Health Partners, Cambridge, CB23 3RE, United Kingdom
| | - G Schiavon
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - L E Friberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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11
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Dimitrakopoulou-Strauss A, Ronellenfitsch U, Cheng C, Pan L, Sachpekidis C, Hohenberger P, Henzler T. Imaging therapy response of gastrointestinal stromal tumors (GIST) with FDG PET, CT and MRI: a systematic review. Clin Transl Imaging 2017; 5:183-197. [PMID: 29104864 PMCID: PMC5658474 DOI: 10.1007/s40336-017-0229-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/17/2017] [Indexed: 12/14/2022]
Abstract
Purpose Improvement of the therapeutic approaches in gastrointestinal stromal tumors (GIST) by the introduction of targeted therapies requires appropriate diagnostic tools, which allow sufficient assessment of therapeutic response, including differentiation of true progression from pseudoprogression due to myxoid degeneration or intratumoral hemorrhage. In this literature review the impact and limitations of different imaging modalities used in GIST therapy monitoring are discussed. Methods PubMed and Cochrane library search were performed using appropriate keywords. Overall, 39 original papers fulfilled the defined criteria and were included in this systematic review. Results Morphological imaging modalities like computed tomography (CT) are primarily used for both diagnosis and therapy monitoring. However, therapy with tyrosine kinase inhibitors and other targeted therapies in GIST may lead only to a minor tumor volume reduction even in cases of response. Therefore, the use of Response Evaluation Criteria in Solid Tumors (RECIST) has limitations. To overcome those limitations, modified response criteria have been introduced for the CT-based therapy assessment, like the Choi criteria as well as criteria based on dual energy CT studies. Functional imaging techniques, mostly based on FDG PET-CT are in use, in particular for the assessment of early treatment response. Conclusions The impact and the limitations of PET-based therapy monitoring, as well as its comparison with CT, MRI and survival data are discussed in this review. CT is still the standard method for the evaluation of therapy response despite its several limitations. FDG PET-CT is helpful for the assessment of early therapy response; however, more prospective data are needed to define its role as well as the appropriate time intervals for therapy monitoring. A multiparametric evaluation based on changes in both morphological and functional data has to be assessed in further prospective studies.
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Affiliation(s)
- Antonia Dimitrakopoulou-Strauss
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Ulrich Ronellenfitsch
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Caixia Cheng
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Leyun Pan
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Christos Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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12
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Tirumani SH, Baheti AD, Tirumani H, O'Neill A, Jagannathan JP. Update on Gastrointestinal Stromal Tumors for Radiologists. Korean J Radiol 2017; 18:84-93. [PMID: 28096720 PMCID: PMC5240484 DOI: 10.3348/kjr.2017.18.1.84] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/14/2016] [Indexed: 12/19/2022] Open
Abstract
The management of gastrointestinal stromal tumors (GISTs) has evolved significantly in the last two decades due to better understanding of their biologic behavior as well as development of molecular targeted therapies. GISTs with exon 11 mutation respond to imatinib whereas GISTs with exon 9 or succinate dehydrogenase subunit mutations do not. Risk stratification models have enabled stratifying GISTs according to risk of recurrence and choosing patients who may benefit from adjuvant therapy. Assessing response to targeted therapies in GIST using conventional response criteria has several potential pitfalls leading to search for alternate response criteria based on changes in tumor attenuation, volume, metabolic and functional parameters. Surveillance of patients with GIST in the adjuvant setting is important for timely detection of recurrences.
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Affiliation(s)
- Sree Harsha Tirumani
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Akshay D. Baheti
- Department of Radiology, Tata Memorial Centre, Mumbai 400012, India
| | - Harika Tirumani
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Ailbhe O'Neill
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Jyothi P. Jagannathan
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
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13
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14
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Tirumani SH, Shinagare AB, O'Neill AC, Nishino M, Rosenthal MH, Ramaiya NH. Accuracy and feasibility of estimated tumour volumetry in primary gastric gastrointestinal stromal tumours: validation using semiautomated technique in 127 patients. Eur Radiol 2015; 26:286-95. [PMID: 25991487 DOI: 10.1007/s00330-015-3829-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 04/24/2015] [Accepted: 04/28/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To validate estimated tumour volumetry in primary gastric gastrointestinal stromal tumours (GISTs) using semiautomated volumetry. METHODS In this IRB-approved retrospective study, we measured the three longest diameters in x, y, z axes on CTs of primary gastric GISTs in 127 consecutive patients (52 women, 75 men, mean age 61 years) at our institute between 2000 and 2013. Segmented volumes (Vsegmented) were obtained using commercial software by two radiologists. Estimate volumes (V1-V6) were obtained using formulae for spheres and ellipsoids. Intra- and interobserver agreement of Vsegmented and agreement of V1-6 with Vsegmented were analysed with concordance correlation coefficients (CCC) and Bland-Altman plots. RESULTS Median Vsegmented and V1-V6 were 75.9, 124.9, 111.6, 94.0, 94.4, 61.7 and 80.3 cm(3), respectively. There was strong intra- and interobserver agreement for Vsegmented. Agreement with Vsegmented was highest for V6 (scalene ellipsoid, x ≠ y ≠ z), with CCC of 0.96 [95 % CI 0.95-0.97]. Mean relative difference was smallest for V6 (0.6 %), while it was -19.1 % for V5, +14.5 % for V4, +17.9 % for V3, +32.6 % for V2 and +47 % for V1. CONCLUSION Ellipsoidal approximations of volume using three measured axes may be used to closely estimate Vsegmented when semiautomated techniques are unavailable. KEY POINTS Estimation of tumour volume in primary GIST using mathematical formulae is feasible. Gastric GISTs are rarely spherical. Segmented volumes are highly concordant with three axis-based scalene ellipsoid volumes. Ellipsoid volume can be used as an alternative for automated tumour volumetry.
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Affiliation(s)
- Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA. .,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Atul B Shinagare
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Ailbhe C O'Neill
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Mizuki Nishino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael H Rosenthal
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Nikhil H Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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15
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Litière S, De Vries EGE, Seymour L, Sargent D, Shankar L, Bogaerts J. Reply to Verlingue, Koscielny and Ferté. Eur J Cancer 2014; 50:2889-91. [PMID: 25219450 DOI: 10.1016/j.ejca.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/01/2014] [Indexed: 12/01/2022]
Affiliation(s)
- S Litière
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - E G E De Vries
- Department of Medical Oncology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - L Seymour
- NCIC Clinical trials group, Queens University, Kingston, Canada
| | - D Sargent
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - L Shankar
- NCI Cancer Imaging Program, National Institutes of Health, Bethesda, MA, United States
| | - J Bogaerts
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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