1
|
Cheng Z, Ma J, Yin L, Yu L, Yuan Z, Zhang B, Tian J, Du Y. Non-invasive molecular imaging for precision diagnosis of metastatic lymph nodes: opportunities from preclinical to clinical applications. Eur J Nucl Med Mol Imaging 2023; 50:1111-1133. [PMID: 36443568 DOI: 10.1007/s00259-022-06056-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022]
Abstract
Lymph node metastasis is an indicator of the invasiveness and aggressiveness of cancer. It is a vital prognostic factor in clinical staging of the disease and therapeutic decision-making. Patients with positive metastatic lymph nodes are likely to develop recurrent disease, distant metastasis, and succumb to death in the coming few years. Lymph node dissection and histological analysis are needed to detect whether regional lymph nodes have been infiltrated by cancer cells and determine the likely outcome of treatment and the patient's chances of survival. However, these procedures are invasive, and tissue biopsies are prone to sampling error. In recent years, advanced molecular imaging with novel imaging probes has provided new technologies that are contributing to comprehensive management of cancer, including non-invasive investigation of lymphatic drainage from tumors, identifying metastatic lymph nodes, and guiding surgeons to operate efficiently in patients with complex lesions. In this review, first, we outline the current status of different molecular imaging modalities applied for lymph node metastasis management. Second, we summarize the multi-functional imaging probes applied with the different imaging modalities as well as applications of cancer lymph node metastasis from preclinical studies to clinical translations. Third, we describe the limitations that must be considered in the field of molecular imaging for improved detection of lymph node metastasis. Finally, we propose future directions for molecular imaging technology that will allow more personalized treatment plans for patients with lymph node metastasis.
Collapse
Affiliation(s)
- Zhongquan Cheng
- Department of General Surgery, Capital Medical University, Beijing Friendship Hospital, Beijing, 100050, China.,CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Jiaojiao Ma
- Department of Medical Ultrasonics, China-Japan Friendship Hospital, Yinghua East Road 2#, ChaoYang Dist., Beijing, 100029, China
| | - Lin Yin
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100080, China
| | - Leyi Yu
- Department of General Surgery, Capital Medical University, Beijing Friendship Hospital, Beijing, 100050, China
| | - Zhu Yuan
- Department of General Surgery, Capital Medical University, Beijing Friendship Hospital, Beijing, 100050, China.
| | - Bo Zhang
- Department of Medical Ultrasonics, China-Japan Friendship Hospital, Yinghua East Road 2#, ChaoYang Dist., Beijing, 100029, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine Science and Engineering, Beihang University, Beijing, 100191, China.
| | - Yang Du
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100080, China.
| |
Collapse
|
2
|
Soliman MA, Kelahan LC, Magnetta M, Savas H, Agrawal R, Avery RJ, Aouad P, Liu B, Xue Y, Chae YK, Salem R, Benson AB, Yaghmai V, Velichko YS. A Framework for Harmonization of Radiomics Data for Multicenter Studies and Clinical Trials. JCO Clin Cancer Inform 2022; 6:e2200023. [PMID: 36332157 PMCID: PMC9668564 DOI: 10.1200/cci.22.00023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/01/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Variability in computed tomography images intrinsic to individual scanners limits the application of radiomics in clinical and research settings. The development of reproducible and generalizable radiomics-based models to assess lesions requires harmonization of data. The purpose of this study was to develop, test, and analyze the efficacy of a radiomics data harmonization model. MATERIALS AND METHODS Radiomic features from biopsy-proven untreated hepatic metastasis (N = 380) acquired from 167 unique patients with pancreatic, colon, and breast cancers were analyzed. Radiomic features from volume-match 551 samples of normal liver tissue and 188 hepatic cysts were included as references. A novel linear mixed effect model was used to identify effects associated with lesion size, tissue type, and scanner model. Six separate machine learning models were then used to test the effectiveness of radiomic feature harmonization using multivariate analysis. RESULTS Proposed model identifies and removes scanner-associated effects while preserving cancer-specific functional dependence of radiomic features on the tumor size. Data harmonization improves the performance of classification models by reducing the scanner-associated variability. For example, the multiclass logistic regression model, LogitBoost, demonstrated the improvement in sensitivity in the range from 15% to 40% for each type of liver metastasis, whereas the overall model accuracy and the kappa coefficient increased by 5% and 8% accordingly. CONCLUSION The model removed scanner-associated effects while preserving cancer-specific functional dependence of radiomic features.
Collapse
Affiliation(s)
- Moataz A.S. Soliman
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Linda C. Kelahan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael Magnetta
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Hatice Savas
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rishi Agrawal
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ryan J. Avery
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Pascale Aouad
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Benjamin Liu
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Yue Xue
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Young K. Chae
- Department of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Riad Salem
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Al B. Benson
- Department of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Vahid Yaghmai
- Department of Radiological Sciences, University of California, Irvine UCI Health, University of California Irvine, Orange, CA
| | - Yuri S. Velichko
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| |
Collapse
|
3
|
Sharma B, Jurgensen-Rauch A, Pace E, Attygalle AD, Sharma R, Bommier C, Wotherspoon AC, Sharma S, Iyengar S, El-Sharkawi D. Breast Implant-associated Anaplastic Large Cell Lymphoma: Review and Multiparametric Imaging Paradigms. Radiographics 2020; 40:609-628. [PMID: 32302264 DOI: 10.1148/rg.2020190198] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a new provisional category in the 2016 World Health Organization (WHO) classification of lymphoid neoplasms, and its incidence is rising owing to increasing recognition of this complication of breast implant insertion. At a median of 10 years after implant insertion, the typical presenting features are sudden-onset breast swelling secondary to peri-implant effusion and less frequently mass-forming disease. Histologic features comprise pleomorphic cells expressing CD30 and negative anaplastic lymphoma kinase (ALK) receptor, similar to systemic and cutaneous ALK-negative anaplastic large cell lymphoma (ALCL). The effusion-only subtype is generally indolent and curable with surgery, unlike the more aggressive mass-forming disease, for which systemic therapy is advocated. High clinical suspicion and pertinent use of radiologic and pathology modalities are essential for timely and accurate diagnosis of BIA-ALCL. Contemporary imaging techniques including US, mammography, breast MRI, CT, and PET/CT are routinely used in breast disease and lymphomas; however, the unique behavior of BIA-ALCL presents significant diagnostic and radiologic interpretative challenges, with numerous nuanced imaging features being pertinent, and current lymphoma staging and response guidelines are not easily applicable to BIA-ALCL. The authors evaluate available evidence in this evolving field; detail key indications, strengths, and limitations of the panoply of radiologic techniques for BIA-ALCL; and propose multiparametric imaging paradigms for management of the peri-implant effusion and mass-forming or advanced disease subtypes, with the goal of accurate optimal patient care. The authors also predict a future model of multimodal assessment using novel imaging and molecular techniques and define key research directions. ©RSNA, 2020.
Collapse
Affiliation(s)
- Bhupinder Sharma
- From the Departments of Radiology (B.S., E.P.), Hematopathology (A.D.A., A.C.W.), Oncology (C.B.), and Hematology (S.S., S.I., D.E.S.), Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England; Department of Medical Oncology, Royal Marsden Hospital Chelsea, London, England (A.J.R.); and University of Exeter Medical School, Exeter, England (R.S.)
| | - Amanda Jurgensen-Rauch
- From the Departments of Radiology (B.S., E.P.), Hematopathology (A.D.A., A.C.W.), Oncology (C.B.), and Hematology (S.S., S.I., D.E.S.), Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England; Department of Medical Oncology, Royal Marsden Hospital Chelsea, London, England (A.J.R.); and University of Exeter Medical School, Exeter, England (R.S.)
| | - Erika Pace
- From the Departments of Radiology (B.S., E.P.), Hematopathology (A.D.A., A.C.W.), Oncology (C.B.), and Hematology (S.S., S.I., D.E.S.), Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England; Department of Medical Oncology, Royal Marsden Hospital Chelsea, London, England (A.J.R.); and University of Exeter Medical School, Exeter, England (R.S.)
| | - Ayoma D Attygalle
- From the Departments of Radiology (B.S., E.P.), Hematopathology (A.D.A., A.C.W.), Oncology (C.B.), and Hematology (S.S., S.I., D.E.S.), Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England; Department of Medical Oncology, Royal Marsden Hospital Chelsea, London, England (A.J.R.); and University of Exeter Medical School, Exeter, England (R.S.)
| | - Rajaei Sharma
- From the Departments of Radiology (B.S., E.P.), Hematopathology (A.D.A., A.C.W.), Oncology (C.B.), and Hematology (S.S., S.I., D.E.S.), Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England; Department of Medical Oncology, Royal Marsden Hospital Chelsea, London, England (A.J.R.); and University of Exeter Medical School, Exeter, England (R.S.)
| | - Côme Bommier
- From the Departments of Radiology (B.S., E.P.), Hematopathology (A.D.A., A.C.W.), Oncology (C.B.), and Hematology (S.S., S.I., D.E.S.), Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England; Department of Medical Oncology, Royal Marsden Hospital Chelsea, London, England (A.J.R.); and University of Exeter Medical School, Exeter, England (R.S.)
| | - Andrew C Wotherspoon
- From the Departments of Radiology (B.S., E.P.), Hematopathology (A.D.A., A.C.W.), Oncology (C.B.), and Hematology (S.S., S.I., D.E.S.), Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England; Department of Medical Oncology, Royal Marsden Hospital Chelsea, London, England (A.J.R.); and University of Exeter Medical School, Exeter, England (R.S.)
| | - Sarkhara Sharma
- From the Departments of Radiology (B.S., E.P.), Hematopathology (A.D.A., A.C.W.), Oncology (C.B.), and Hematology (S.S., S.I., D.E.S.), Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England; Department of Medical Oncology, Royal Marsden Hospital Chelsea, London, England (A.J.R.); and University of Exeter Medical School, Exeter, England (R.S.)
| | - Sunil Iyengar
- From the Departments of Radiology (B.S., E.P.), Hematopathology (A.D.A., A.C.W.), Oncology (C.B.), and Hematology (S.S., S.I., D.E.S.), Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England; Department of Medical Oncology, Royal Marsden Hospital Chelsea, London, England (A.J.R.); and University of Exeter Medical School, Exeter, England (R.S.)
| | - Dima El-Sharkawi
- From the Departments of Radiology (B.S., E.P.), Hematopathology (A.D.A., A.C.W.), Oncology (C.B.), and Hematology (S.S., S.I., D.E.S.), Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England; Department of Medical Oncology, Royal Marsden Hospital Chelsea, London, England (A.J.R.); and University of Exeter Medical School, Exeter, England (R.S.)
| |
Collapse
|
4
|
Comparative Analysis of Clinical and Pathological Lymph Node Staging Data in Head and Neck Squamous Cell Carcinoma Patients Treated at the General Hospital Vienna. Radiol Oncol 2018; 52:173-180. [PMID: 30018521 PMCID: PMC6043886 DOI: 10.2478/raon-2018-0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/04/2018] [Indexed: 12/28/2022] Open
Abstract
Background Results from publications evaluating discrepancies between clinical staging data in relation to pathological findings demonstrate that a significant number of head and neck squamous cell carcinoma (HNSCC) patients are not correctly staged. The aim of this retrospective study was to analyze potential discrepancies of radiological assessment versus pathological data of regional lymph node involvement and to compare the results with data published in the literature. Patients and methods In a retrospective analysis we focused on patients with HNSCC routinely treated by surgery plus postoperative radiotherapy between 2002 and 2012. For inclusion, complete pre-operative clinical staging information with lymph node status and patho-histological information on involved lymph node regions as well as survival outcome data were mandatory. We included 87 patients (UICC stage III-IV 90.8%) for which the aforementioned data obtained by CT or MRI were available. Overall survival rates were estimated by the Kaplan-Meier method. The Pearson correlation coefficient and Spearman's rank correlation coefficient (non-linear relationship) was calculated. Results Discrepancies at the level of overall tumour stage assessment were noticed in 27.5% of all cases. Thereof, 5.7% were assigned to patho-histological up-staging or down-staging of the primary tumour. At the lymph node level, 11.5% of the patients were downstaged, and 10.3% were upstaged. Conclusions The study showed that in approximately one-fifth (21.8%) of the patients, lymph node assessment by CT or MRI differs from the pathologic staging, an outcome that corresponds well with those published by several other groups in this field.
Collapse
|
5
|
Schork NJ, Nazor K. Integrated Genomic Medicine: A Paradigm for Rare Diseases and Beyond. ADVANCES IN GENETICS 2017; 97:81-113. [PMID: 28838357 PMCID: PMC6383766 DOI: 10.1016/bs.adgen.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Individualized medicine, or the tailoring of therapeutic interventions to a patient's unique genetic, biochemical, physiological, exposure and behavioral profile, has been enhanced, if not enabled, by modern biomedical technologies such as high-throughput DNA sequencing platforms, induced pluripotent stem cell assays, biomarker discovery protocols, imaging modalities, and wireless monitoring devices. Despite successes in the isolated use of these technologies, however, it is arguable that their combined and integrated use in focused studies of individual patients is the best way to not only tailor interventions for those patients, but also shed light on treatment strategies for patients with similar conditions. This is particularly true for individuals with rare diseases since, by definition, they will require study without recourse to other individuals, or at least without recourse to many other individuals. Such integration and focus will require new biomedical scientific paradigms and infrastructure, including the creation of databases harboring study results, the formation of dedicated multidisciplinary research teams and new training programs. We consider the motivation and potential for such integration, point out areas in need of improvement, and argue for greater emphasis on improving patient health via technological innovations, not merely improving the technologies themselves. We also argue that the paradigm described can, in theory, be extended to the study of individuals with more common diseases.
Collapse
Affiliation(s)
- Nicholas J. Schork
- The Translational Genomics Research Institute, 445 North Fifth Street, Phoenix, AZ 85004, , 858-794-4054
| | - Kristopher Nazor
- MYi Diagnostics and Discovery, 5310 Eastgate Mall, San Diego, CA 92121, , 858-458-9305
| |
Collapse
|
6
|
Yue Y, Osipov A, Fraass B, Sandler H, Zhang X, Nissen N, Hendifar A, Tuli R. Identifying prognostic intratumor heterogeneity using pre- and post-radiotherapy 18F-FDG PET images for pancreatic cancer patients. J Gastrointest Oncol 2017; 8:127-138. [PMID: 28280617 DOI: 10.21037/jgo.2016.12.04] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To stratify risks of pancreatic adenocarcinoma (PA) patients using pre- and post-radiotherapy (RT) PET/CT images, and to assess the prognostic value of texture variations in predicting therapy response of patients. METHODS Twenty-six PA patients treated with RT from 2011-2013 with pre- and post-treatment 18F-FDG-PET/CT scans were identified. Tumor locoregional texture was calculated using 3D kernel-based approach, and texture variations were identified by fitting discrepancies of texture maps of pre- and post-treatment images. A total of 48 texture and clinical variables were identified and evaluated for association with overall survival (OS). The prognostic heterogeneity features were selected using lasso/elastic net regression, and further were evaluated by multivariate Cox analysis. RESULTS Median age was 69 y (range, 46-86 y). The texture map and temporal variations between pre- and post-treatment were well characterized by histograms and statistical fitting. The lasso analysis identified seven predictors (age, node stage, post-RT SUVmax, variations of homogeneity, variance, sum mean, and cluster tendency). The multivariate Cox analysis identified five significant variables: age, node stage, variations of homogeneity, variance, and cluster tendency (with P=0.020, 0.040, 0.065, 0.078, and 0.081, respectively). The patients were stratified into two groups based on the risk score of multivariate analysis with log-rank P=0.001: a low risk group (n=11) with a longer mean OS (29.3 months) and higher texture variation (>30%), and a high risk group (n=15) with a shorter mean OS (17.7 months) and lower texture variation (<15%). CONCLUSIONS Locoregional metabolic texture response provides a feasible approach for evaluating and predicting clinical outcomes following treatment of PA with RT. The proposed method can be used to stratify patient risk and help select appropriate treatment strategies for individual patients toward implementing response-driven adaptive RT.
Collapse
Affiliation(s)
- Yong Yue
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arsen Osipov
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Benedick Fraass
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Howard Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Xiao Zhang
- Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nicholas Nissen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Hendifar
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard Tuli
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
7
|
He H, Zheng X, Zhang J, Liu S, Hu X, Xie Z. Photothermally induced accumulation and retention of polymeric nanoparticles in tumors for long-term fluorescence imaging. J Mater Chem B 2017; 5:2491-2499. [DOI: 10.1039/c6tb02650h] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Photothermal induced accumulation and retention of polymeric nanoparticles in tumor is used for long-term fluorescent imaging.
Collapse
Affiliation(s)
- Haozhe He
- State Key Laboratory of Polymer Physics and Chemistry
- Changchun
- Institute of Applied Chemistry
- Chinese Academy of Sciences
- Changchun 130022
| | - Xiaohua Zheng
- State Key Laboratory of Polymer Physics and Chemistry
- Changchun
- Institute of Applied Chemistry
- Chinese Academy of Sciences
- Changchun 130022
| | - Jianxu Zhang
- State Key Laboratory of Polymer Physics and Chemistry
- Changchun
- Institute of Applied Chemistry
- Chinese Academy of Sciences
- Changchun 130022
| | - Shi Liu
- State Key Laboratory of Polymer Physics and Chemistry
- Changchun
- Institute of Applied Chemistry
- Chinese Academy of Sciences
- Changchun 130022
| | - Xiuli Hu
- State Key Laboratory of Polymer Physics and Chemistry
- Changchun
- Institute of Applied Chemistry
- Chinese Academy of Sciences
- Changchun 130022
| | - Zhigang Xie
- State Key Laboratory of Polymer Physics and Chemistry
- Changchun
- Institute of Applied Chemistry
- Chinese Academy of Sciences
- Changchun 130022
| |
Collapse
|
8
|
Harmon SA, Tuite MJ, Jeraj R. Molecular image-directed biopsies: improving clinical biopsy selection in patients with multiple tumors. Phys Med Biol 2016; 61:7282-7299. [PMID: 27694707 DOI: 10.1088/0031-9155/61/20/7282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Site selection for image-guided biopsies in patients with multiple lesions is typically based on clinical feasibility and physician preference. This study outlines the development of a selection algorithm that, in addition to clinical requirements, incorporates quantitative imaging data for automatic identification of candidate lesions for biopsy. The algorithm is designed to rank potential targets by maximizing a lesion-specific score, incorporating various criteria separated into two categories: (1) physician-feasibility category including physician-preferred lesion location and absolute volume scores, and (2) imaging-based category including various modality and application-specific metrics. This platform was benchmarked in two clinical scenarios, a pre-treatment setting and response-based setting using imaging from metastatic prostate cancer patients with high disease burden (multiple lesions) undergoing conventional treatment and receiving whole-body [18F]NaF PET/CT scans pre- and mid-treatment. Targeting of metastatic lesions was robust to different weighting ratios and candidacy for biopsy was physician confirmed. Lesion ranked as top targets for biopsy remained so for all patients in pre-treatment and post-treatment biopsy selection after sensitivity testing was completed for physician-biased or imaging-biased scenarios. After identifying candidates, biopsy feasibility was evaluated by a physician and confirmed for 90% (32/36) of high-ranking lesions, of which all top choices were confirmed. The remaining cases represented lesions with high anatomical difficulty for targeting, such as proximity to sciatic nerve. This newly developed selection method was successfully used to quantitatively identify candidate lesions for biopsies in patients with multiple lesions. In a prospective study, we were able to successfully plan, develop, and implement this technique for the selection of a pre-treatment biopsy location.
Collapse
Affiliation(s)
- Stephanie A Harmon
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 7033 Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Madison, WI 53705, USA
| | | | | |
Collapse
|
9
|
Zhang Z, Li M, Chen F, Li L, Liu J, Li Z, Ji R, Zuo X, Li Y. Probe-Based Confocal Laser Endomicroscopy for Imaging TRAIL-Expressing Mesenchymal Stem Cells to Monitor Colon Xenograft Tumors In Vivo. PLoS One 2016; 11:e0162700. [PMID: 27617958 PMCID: PMC5019474 DOI: 10.1371/journal.pone.0162700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 08/27/2016] [Indexed: 12/13/2022] Open
Abstract
Introduction Mesenchymal stem cells (MSCs) can serve as vehicles for therapeutic genes. However, little is known about MSC behavior in vivo. Here, we demonstrated that probe-based confocal laser endomicroscopy (pCLE) can be used to track MSCs in vivo and individually monitor tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) gene expression within carcinomas. Methods Isolated BALB/c nu/nu mice MSCs (MSCs) were characterized and engineered to co-express the TRAIL and enhanced green fluorescent protein (EGFP) genes. The number of MSCs co-expressing EGFP and TRAIL (TRAIL-MSCs) at tumor sites was quantified with pCLE in vivo, while their presence was confirmed using immunofluorescence (IF) and quantitative polymerase chain reaction (qPCR). The therapeutic effects of TRAIL-MSCs were evaluated by measuring the volumes and weights of subcutaneous HT29-derived xenograft tumors. Results Intravital imaging of the subcutaneous xenograft tumors revealed that BALB/c mice treated with TRAIL-MSCs exhibited specific cellular signals, whereas no specific signals were observed in the control mice. The findings from the pCLE images were consistent with the IF and qPCR results. Conclusion The pCLE results indicated that endomicroscopy could effectively quantify injected MSCs that homed to subcutaneous xenograft tumor sites in vivo and correlated well with the therapeutic effects of the TRAIL gene. By applying pCLE for the in vivo monitoring of cellular trafficking, stem cell-based anticancer gene therapeutic approaches might be feasible and attractive options for individualized clinical treatments.
Collapse
Affiliation(s)
- Zhen Zhang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Ming Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Feixue Chen
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Lixiang Li
- Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Jun Liu
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Rui Ji
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiuli Zuo
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Yanqing Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- * E-mail:
| |
Collapse
|
10
|
Safavi M, Sabourian R, Abdollahi M. The development of biomarkers to reduce attrition rate in drug discovery focused on oncology and central nervous system. Expert Opin Drug Discov 2016; 11:939-56. [DOI: 10.1080/17460441.2016.1217196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
11
|
Hyaluronic acid embedded cellulose acetate phthlate core/shell nanoparticulate carrier of 5-fluorouracil. Int J Biol Macromol 2016; 87:449-59. [DOI: 10.1016/j.ijbiomac.2015.11.094] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 11/23/2022]
|
12
|
Rossanese O, Eccles S, Springer C, Swain A, Raynaud FI, Workman P, Kirkin V. The pharmacological audit trail (PhAT): Use of tumor models to address critical issues in the preclinical development of targeted anticancer drugs. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ddmod.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
13
|
Emblem KE, Farrar CT, Gerstner ER, Batchelor TT, Borra RJH, Rosen BR, Sorensen AG, Jain RK. Vessel caliber--a potential MRI biomarker of tumour response in clinical trials. Nat Rev Clin Oncol 2014; 11:566-84. [PMID: 25113840 PMCID: PMC4445139 DOI: 10.1038/nrclinonc.2014.126] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Our understanding of the importance of blood vessels and angiogenesis in cancer has increased considerably over the past decades, and the assessment of tumour vessel calibre and structure has become increasingly important for in vivo monitoring of therapeutic response. The preferred method for in vivo imaging of most solid cancers is MRI, and the concept of vessel-calibre MRI has evolved since its initial inception in the early 1990s. Almost a quarter of a century later, unlike traditional contrast-enhanced MRI techniques, vessel-calibre MRI remains widely inaccessible to the general clinical community. The narrow availability of the technique is, in part, attributable to limited awareness and a lack of imaging standardization. Thus, the role of vessel-calibre MRI in early phase clinical trials remains to be determined. By contrast, regulatory approvals of antiangiogenic agents that are not directly cytotoxic have created an urgent need for clinical trials incorporating advanced imaging analyses, going beyond traditional assessments of tumour volume. To this end, we review the field of vessel-calibre MRI and summarize the emerging evidence supporting the use of this technique to monitor response to anticancer therapy. We also discuss the potential use of this biomarker assessment in clinical imaging trials and highlight relevant avenues for future research.
Collapse
Affiliation(s)
- Kyrre E Emblem
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Christian T Farrar
- Department of Radiology and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Elizabeth R Gerstner
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom Street, Boston, MA 02114, USA
| | - Tracy T Batchelor
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom Street, Boston, MA 02114, USA
| | - Ronald J H Borra
- Department of Radiology and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Bruce R Rosen
- Department of Radiology and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - A Gregory Sorensen
- Siemens Healthcare Health Services, 51 Valley Stream Parkway, Malvern, PA 19355, USA
| | - Rakesh K Jain
- Edwin L. Steele Laboratory of Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom Street, Boston, MA 02114, USA
| |
Collapse
|
14
|
Zheng M, Zhao P, Luo Z, Gong P, Zheng C, Zhang P, Yue C, Gao D, Ma Y, Cai L. Robust ICG theranostic nanoparticles for folate targeted cancer imaging and highly effective photothermal therapy. ACS APPLIED MATERIALS & INTERFACES 2014; 6:6709-16. [PMID: 24697646 DOI: 10.1021/am5004393] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Folic acid (FA)-targeted indocyanine green (ICG)-loaded nanoparticles (NPs) (FA-INPs) were developed to a near-infrared (NIR) fluorescence theranostic nanoprobe for targeted imaging and photothermal therapy of cancer. The FA-INPs with good monodispersity exhibited excellent size and fluorescence stability, preferable temperature response under laser irradiation, and specific molecular targeting to MCF-7 cells with FA receptor overexpression, compared to free ICG. The FA-INPs enabled NIR fluorescence imaging to in situ monitor the tumor accumulation of the ICG. The cell survival rate assays in vitro and photothermal therapy treatments in vivo indicated that FA-INPs could efficiently targeted and suppressed MCF-7 cells and xenograft tumors. Hence, the FA-INPs are notable theranostic NPs for imaging-guided cancer therapy in clinical application.
Collapse
Affiliation(s)
- Mingbin Zheng
- Department of Chemistry, Guangdong Medical College , Dongguan 523808, People's Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Martinez-Quintanilla J, Bhere D, Heidari P, He D, Mahmood U, Shah K. Therapeutic efficacy and fate of bimodal engineered stem cells in malignant brain tumors. Stem Cells 2013; 31:1706-14. [PMID: 23389839 PMCID: PMC3775922 DOI: 10.1002/stem.1355] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 12/31/2012] [Indexed: 12/28/2022]
Abstract
Therapeutically engineered stem cells (SC) are emerging as an effective tumor-targeted approach for different cancer types. However, the assessment of the long-term fate of therapeutic SC post-tumor treatment is critical if such promising therapies are to be translated into clinical practice. In this study, we have developed an efficient SC-based therapeutic strategy that simultaneously allows killing of tumor cells and assessment and eradication of SC after treatment of highly malignant glioblastoma multiforme (GBM). Mesenchymal stem cells (MSC) engineered to co-express the prodrug converting enzyme, herpes simplex virus thymidine kinase (HSV-TK) and a potent and secretable variant of tumor necrosis factor apoptosis-inducing ligand (S-TRAIL) induced caspase-mediated GBM cell death and showed selective MSC sensitization to the prodrug ganciclovir (GCV). A significant decrease in tumor growth and a subsequent increase in survival were observed when mice bearing highly aggressive GBM were treated with MSC coexpressing S-TRAIL and HSV-TK. Furthermore, the systemic administration of GCV post-tumor treatment selectively eliminated therapeutic MSC expressing HSV-TK in vitro and in vivo, which was monitored in real time by positron emission-computed tomography imaging using 18F-FHBG, a substrate for HSV-TK. These findings demonstrate the development and validation of a novel therapeutic strategy that has implications in translating SC-based therapies in cancer patients.
Collapse
Affiliation(s)
- Jordi Martinez-Quintanilla
- Molecular Neurotherapy and Imaging Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
| | - Deepak Bhere
- Molecular Neurotherapy and Imaging Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
| | - Pedram Heidari
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
| | - Derek He
- Molecular Neurotherapy and Imaging Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
| | - Umar Mahmood
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
| | - Khalid Shah
- Molecular Neurotherapy and Imaging Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, 02114
- Harvard Stem Cell Institute, Harvard University, Cambridge, Massachusetts 02138
| |
Collapse
|
16
|
Qiang L, Meng X, Li L, Chen D, Ren X, Liu H, Ren J, Fu C, Liu T, Gao F, Zhang Y, Tang F. Preparation of magnetic rattle-type silica through a general and facile pre-shell-post-core process for simultaneous cancer imaging and therapy. Chem Commun (Camb) 2013; 49:7902-4. [PMID: 23900516 DOI: 10.1039/c3cc43660h] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Here we report a novel pre-shell-post-core method for the fabrication of monodispersed magnetic rattle-type silica (MRS) through an entrapment process, which could be used as a promising theranostic agent for simultaneous magnetic resonance imaging and drug delivery.
Collapse
Affiliation(s)
- Li Qiang
- Laboratory of Controllable Preparation and Application of Nanomaterials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Sharma B, Martin A, Zerizer I. Positron Emission Tomography-Computed Tomography in Liver Imaging. Semin Ultrasound CT MR 2013; 34:66-80. [DOI: 10.1053/j.sult.2012.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
18
|
Marrache S, Pathak RK, Darley KL, Choi JH, Zaver D, Kolishetti N, Dhar S. Nanocarriers for tracking and treating diseases. Curr Med Chem 2013; 20:3500-14. [PMID: 23834187 PMCID: PMC8085808 DOI: 10.2174/0929867311320280007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/04/2013] [Indexed: 12/11/2022]
Abstract
Site directed drug delivery with high efficacy is the biggest challenge in the area of current pharmaceuticals. Biodegradable polymer-based controlled release nanoparticle platforms could be beneficial for targeted delivery of therapeutics and contrast agents for a myriad of important human diseases. Biodegradable nanoparticles, which can be engineered to load multiple drugs with varied physicochemical properties, contrast agents, and cellular or intracellular component targeting moieties, have emerged as potential alternatives for tracking and treating human diseases. In this review, we will highlight the current advances in the design and execution of such platforms for their potential application in the diagnosis and treatment of variety of diseases ranging from cancer to Alzheimer's and we will provide a critical analysis of the associated challenges for their possible clinical translation.
Collapse
Affiliation(s)
- Sean Marrache
- NanoTherapeutics Research Laboratory, Department of Chemistry, University of Georgia, Athens, GA 30602
| | - Rakesh Kumar Pathak
- NanoTherapeutics Research Laboratory, Department of Chemistry, University of Georgia, Athens, GA 30602
| | - Kasey L. Darley
- NanoTherapeutics Research Laboratory, Department of Chemistry, University of Georgia, Athens, GA 30602
| | - Joshua H. Choi
- NanoTherapeutics Research Laboratory, Department of Chemistry, University of Georgia, Athens, GA 30602
| | - Dhillon Zaver
- NanoTherapeutics Research Laboratory, Department of Chemistry, University of Georgia, Athens, GA 30602
| | | | - Shanta Dhar
- NanoTherapeutics Research Laboratory, Department of Chemistry, University of Georgia, Athens, GA 30602
- Department of Physiology and Pharmacology, University of Georgia, Athens, GA 30602, USA
| |
Collapse
|
19
|
Luk BT, Fang RH, Zhang L. Lipid- and polymer-based nanostructures for cancer theranostics. Am J Cancer Res 2012; 2:1117-26. [PMID: 23382770 PMCID: PMC3563151 DOI: 10.7150/thno.4381] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/15/2012] [Indexed: 12/22/2022] Open
Abstract
The relatively new field of nanotheranostics combines the advantages of in vivo diagnosis with the ability to administer treatment through a single nano-sized carrier, offering new opportunities for cancer diagnosis and therapy. Nanotheranostics has facilitated the development of nanomedicine through direct visualization of drug blood circulation and biodistribution. From a clinical perspective, nanotheranostics allows therapies to be administered and monitored in real time, thus decreasing the potential of under- or over-dosing and allowing for more personalized treatment regimens. Herein, we review recent development of nanotheranostics using lipid- and polymer-based formulations, with a particular focus on their applications in cancer research. Recent advances in nanotechnology aimed to combine therapeutic molecules with imaging agents for magnetic resonance imaging, radionuclide imaging, or fluorescence imaging are discussed.
Collapse
|
20
|
Sharma B, Martin A, Stanway S, Johnston SRD, Constantinidou A. Imaging in oncology--over a century of advances. Nat Rev Clin Oncol 2012; 9:728-37. [PMID: 23149892 DOI: 10.1038/nrclinonc.2012.195] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Over the past 120 years, the discipline of oncology has evolved so that a multitude of anatomical and increasingly complex functional imaging techniques are now applicable in both clinical and research platforms. This Timeline article revisits the achievements of the pioneer techniques in cancer imaging, discusses how these techniques have changed over time, provides some examples of clinical importance, and ventures to explain how imaging will remodel the future of modern oncology.
Collapse
Affiliation(s)
- Bhuey Sharma
- Department of Imaging, Royal Marsden Hospital, Fulham Road, London, UK
| | | | | | | | | |
Collapse
|
21
|
Chatni MR, Xia J, Sohn R, Maslov K, Guo Z, Zhang Y, Wang K, Xia Y, Anastasio M, Arbeit J, Wang LV. Tumor glucose metabolism imaged in vivo in small animals with whole-body photoacoustic computed tomography. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:076012. [PMID: 22894495 PMCID: PMC3390466 DOI: 10.1117/1.jbo.17.7.076012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
With the increasing use of small animals for human disease studies, small-animal whole-body molecular imaging plays an important role in biomedical research. Currently, none of the existing imaging modalities can provide both anatomical and glucose molecular information, leading to higher costs of building dual-modality systems. Even with image co-registration, the spatial resolution of the molecular imaging modality is not improved. Utilizing a ring-shaped confocal photoacoustic computed tomography system, we demonstrate, for the first time, that both anatomy and glucose uptake can be imaged in a single modality. Anatomy was imaged with the endogenous hemoglobin contrast, and glucose metabolism was imaged with a near-infrared dye-labeled 2-deoxyglucose.
Collapse
Affiliation(s)
- Muhammad Rameez Chatni
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri 63130
| | - Jun Xia
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri 63130
| | - Rebecca Sohn
- Washington University in St. Louis, Urology Division, Department of Surgery, St. Louis, Missouri 63110
| | - Konstantin Maslov
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri 63130
| | - Zijian Guo
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri 63130
| | - Yu Zhang
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia 30332
| | - Kun Wang
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri 63130
| | - Younan Xia
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia 30332
| | - Mark Anastasio
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri 63130
| | - Jeffrey Arbeit
- Washington University in St. Louis, Urology Division, Department of Surgery, St. Louis, Missouri 63110
| | - Lihong V. Wang
- Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri 63130
- Address all correspondence to: Lihong V. Wang, Washington University in St. Louis, Department of Biomedical Engineering, St. Louis, Missouri 63130. E-mail:
| |
Collapse
|
22
|
FDG-PET is a good biomarker of both early response and acquired resistance in BRAFV600 mutant melanomas treated with vemurafenib and the MEK inhibitor GDC-0973. EJNMMI Res 2012; 2:22. [PMID: 22651703 PMCID: PMC3405466 DOI: 10.1186/2191-219x-2-22] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/31/2012] [Indexed: 12/19/2022] Open
Abstract
Background The BRAF inhibitor, vemurafenib, has recently been approved for the treatment of metastatic melanoma in patients harboring BRAFV600 mutations. Currently, dual BRAF and MEK inhibition are ongoing in clinical trials with the goal of overcoming the acquired resistance that has unfortunately developed in some vemurafenib patients. FDG-PET measures of metabolic activity are increasingly employed as a pharmacodynamic biomarker for guiding single-agent or combination therapies by gauging initial drug response and monitoring disease progression. However, since tumors are inherently heterogeneous, investigating the effects of BRAF and MEK inhibition on FDG uptake in a panel of different melanomas could help interpret imaging outcomes. Methods 18 F-FDG uptake was measured in vitro in cells with wild-type and mutant (V600) BRAF, and in melanoma cells with an acquired resistance to vemurafenib. We treated the cells with vemurafenib alone or in combination with MEK inhibitor GDC-0973. PET imaging was used in mice to measure FDG uptake in A375 melanoma xenografts and in A375 R1, a vemurafenib-resistant derivative. Histological and biochemical studies of glucose transporters, the MAPK and glycolytic pathways were also undertaken. Results We demonstrate that vemurafenib is equally effective at reducing FDG uptake in cell lines harboring either heterozygous or homozygous BRAFV600 but ineffective in cells with acquired resistance or having WT BRAF status. However, combination with GDC-0973 results in a highly significant increase of efficacy and inhibition of FDG uptake across all twenty lines. Drug-induced changes in FDG uptake were associated with altered levels of membrane GLUT-1, and cell lines harboring RAS mutations displayed enhanced FDG uptake upon exposure to vemurafenib. Interestingly, we found that vemurafenib treatment in mice bearing drug-resistant A375 xenografts also induced increased FDG tumor uptake, accompanied by increases in Hif-1α, Sp1 and Ksr protein levels. Vemurafenib and GDC-0973 combination efficacy was associated with decreased levels of hexokinase II, c-RAF, Ksr and p-MEK protein. Conclusions We have demonstrated that 18 F-FDG-PET imaging reflects vemurafenib and GDC-0973 action across a wide range of metastatic melanomas. A delayed post-treatment increase in tumor FDG uptake should be considered carefully as it may well be an indication of acquired drug resistance. Trial registration ClinicalTrials.gov NCT01271803
Collapse
|
23
|
Stacchiotti S, Verderio P, Messina A, Morosi C, Collini P, Llombart-Bosch A, Martin J, Comandone A, Cruz J, Ferraro A, Grignani G, Pizzamiglio S, Quagliuolo V, Picci P, Frustaci S, Dei Tos AP, Casali PG, Gronchi A. Tumor response assessment by modified Choi criteria in localized high-risk soft tissue sarcoma treated with chemotherapy. Cancer 2012; 118:5857-66. [PMID: 22605504 DOI: 10.1002/cncr.27624] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/18/2012] [Accepted: 03/26/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND The objective of this study was to compare the prognostic relevance of Response Evaluation Criteria in Solid Tumors (RECIST) versus Choi criteria for the assessment of response in patients with high-risk soft tissue sarcoma of the extremities or trunk wall who received preoperative chemotherapy with or without radiotherapy in a phase 3 trial. METHODS Patients received 3 cycles of preoperative epirubicin + ifosfamide with or without radiotherapy. The diagnostic concordance between RECIST and Choi criteria and their correlation with overall survival (OS) and freedom from progression (FFP) were evaluated in a univariate Cox regression model. RESULTS In 243 of 321 eligible patients, RECIST, Choi criteria, and histology were predictive for OS and FFP. In the subgroup of 69 patients who received chemotherapy alone and were evaluable by both RECIST and Choi criteria, Choi criteria were associated significantly with OS and FFP, whereas RECIST predicted only FFP, and the pattern of agreement observed between the 2 criteria was unsatisfactory. On a dichotomous scale, comparing objective response (complete and partial responses) and lack of response (stable and progressive disease) to preoperative chemotherapy according to RECIST and Choi criteria, only Choi criteria were predictive of OS and FFP, and fair agreement between RECIST and Choi criteria was observed. When lack of progression and progression were compared (complete and partial responses + stable disease vs progressive disease), both assessment criteria were significantly predictive of OS and FFP, and there was substantial agreement between the 2 criteria. CONCLUSIONS Response to chemotherapy with or without radiotherapy was associated with a better outcome in patients with high-risk soft tissue sarcoma. Choi criteria were better predictors than RECIST in patients who received preoperative chemotherapy alone.
Collapse
Affiliation(s)
- Silvia Stacchiotti
- Department of Cancer Medicine, Scientific Institute for Research and Treatment Foundation, National Cancer Institute, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|