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Gerwing M, Krähling T, Schliemann C, Harrach S, Schwöppe C, Berdel AF, Klein S, Hartmann W, Wardelmann E, Heindel WL, Lenz G, Berdel WE, Wildgruber M. Multiparametric Magnetic Resonance Imaging for Immediate Target Hit Assessment of CD13-Targeted Tissue Factor tTF-NGR in Advanced Malignant Disease. Cancers (Basel) 2021; 13:cancers13235880. [PMID: 34884988 PMCID: PMC8657298 DOI: 10.3390/cancers13235880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Since the knowledge of tumor biology has advanced, a variety of targeted therapies has been developed. These do not immediately affect the tumor size, so optimized oncological imaging is needed. In this phase I study of patients with advanced malignant disease, a multiparametric imaging approach was used to assess changes in tumor perfusion after vessel-occluding therapy with the CD13 targeted truncated tissue factor with a C-terminal NGR-peptide. It comprises different sequences and the use of two different contrast media, ferucarbotran and gadobutrol. This multiparametric MRI protocol enables assessing the therapy effectiveness as early as five hours after therapy initiation. Abstract Early assessment of target hit in anti-cancer therapies is a major task in oncologic imaging. In this study, immediate target hit and effectiveness of CD13-targeted tissue factor tTF-NGR in patients with advanced malignant disease enrolled in a phase I trial was assessed using a multiparametric MRI protocol. Seventeen patients with advanced solid malignancies were enrolled in the trial and received tTF-NGR for at least one cycle of five daily infusions. Tumor target lesions were imaged with multiparametric MRI before therapy initiation, five hours after the first infusion and after five days. The imaging protocol comprised ADC, calculated from DWI, and DCE imaging and vascular volume fraction (VVF) assessment. DCE and VVF values decreased within 5 h after therapy initiation, indicating early target hit with a subsequent decrease in tumor perfusion due to selective tumor vessel occlusion and thrombosis induced by tTF-NGR. Simultaneously, ADC values increased at five hours after tTF-NGR administration. In four patients, treatment had to be stopped due to an increase in troponin T hs, with subsequent anticoagulation. In these patients, a reversed effect, with DCE and VVF values increasing and ADC values decreasing, was observed after anticoagulation. Changes in imaging parameters were independent of the mean vessel density determined by immunohistochemistry. By using a multiparametric imaging approach, changes in tumor perfusion after initiation of a tumor vessel occluding therapy can be evaluated as early as five hours after therapy initiation, enabling early assessment of target hit.
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Affiliation(s)
- Mirjam Gerwing
- Clinic of Radiology, University Hospital Muenster, D-48149 Muenster, Germany; (T.K.); (W.L.H.); (M.W.)
- Correspondence:
| | - Tobias Krähling
- Clinic of Radiology, University Hospital Muenster, D-48149 Muenster, Germany; (T.K.); (W.L.H.); (M.W.)
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Saliha Harrach
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Christian Schwöppe
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Andrew F. Berdel
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Sebastian Klein
- Gerhard-Domagk-Institute for Pathology, University of Muenster, D-48149 Muenster, Germany; (S.K.); (W.H.); (E.W.)
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute for Pathology, University of Muenster, D-48149 Muenster, Germany; (S.K.); (W.H.); (E.W.)
| | - Eva Wardelmann
- Gerhard-Domagk-Institute for Pathology, University of Muenster, D-48149 Muenster, Germany; (S.K.); (W.H.); (E.W.)
| | - Walter L. Heindel
- Clinic of Radiology, University Hospital Muenster, D-48149 Muenster, Germany; (T.K.); (W.L.H.); (M.W.)
| | - Georg Lenz
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Wolfgang E. Berdel
- Department of Medicine A, Hematology, Hemostaseology, Oncology and Pulmonology, University Hospital Muenster, D-48149 Muenster, Germany; (C.S.); (S.H.); (C.S.); (A.F.B.); (G.L.); (W.E.B.)
| | - Moritz Wildgruber
- Clinic of Radiology, University Hospital Muenster, D-48149 Muenster, Germany; (T.K.); (W.L.H.); (M.W.)
- Department of Radiology, University Hospital, LMU Munich, D-81377 Munich, Germany
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