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Heinrich MC, Corless CL, Demetri GD, Blanke CD, von Mehren M, Joensuu H, McGreevey LS, Chen CJ, Van den Abbeele AD, Druker BJ, Kiese B, Eisenberg B, Roberts PJ, Singer S, Fletcher CDM, Silberman S, Dimitrijevic S, Fletcher JA. Kinase Mutations and Imatinib Response in Patients With Metastatic Gastrointestinal Stromal Tumor. J Clin Oncol 2023; 41:4829-4836. [PMID: 37890277 DOI: 10.1200/jco.22.02771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Most gastrointestinal stromal tumors (GISTs) express constitutively activated mutant isoforms of KIT or kinase platelet-derived growth factor receptor alpha (PDGFRA) that are potential therapeutic targets for imatinib mesylate. The relationship between mutations in these kinases and clinical response to imatinib was examined in a group of patients with advanced GIST. PATIENTS AND METHODS GISTs from 127 patients enrolled onto a phase II clinical study of imatinib were examined for mutations of KIT or PDGFRA. Mutation types were correlated with clinical outcome. RESULTS Activating mutations of KIT or PDGFRA were found in 112 (88.2%) and six (4.7%) GISTs, respectively. Most KIT mutations involved exon 9 (n = 23) or exon 11 (n = 85). All KIT mutant isoforms, but only a subset of PDGFRA mutant isoforms, were sensitive to imatinib, in vitro. In patients with GISTs harboring exon 11 KIT mutations, the partial response rate (PR) was 83.5%, whereas patients with tumors containing an exon 9 KIT mutation or no detectable mutation of KIT or PDGFRA had PR rates of 47.8% (P = .0006) and 0.0% (P < .0001), respectively. Patients whose tumors contained exon 11 KIT mutations had a longer event-free and overall survival than those whose tumors expressed either exon 9 KIT mutations or had no detectable kinase mutation. CONCLUSION Activating mutations of KIT or PDGFRA are found in the vast majority of GISTs, and the mutational status of these oncoproteins is predictive of clinical response to imatinib. PDGFRA mutations can explain response and sensitivity to imatinib in some GISTs lacking KIT mutations.
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Affiliation(s)
- Michael C Heinrich
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Christopher L Corless
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - George D Demetri
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Charles D Blanke
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Margaret von Mehren
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Heikki Joensuu
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Laura S McGreevey
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Chang-Jie Chen
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Annick D Van den Abbeele
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Brian J Druker
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Beate Kiese
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Burton Eisenberg
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Peter J Roberts
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Samuel Singer
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Christopher D M Fletcher
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Sandra Silberman
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Sasa Dimitrijevic
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
| | - Jonathan A Fletcher
- From the Oregon Health and Science University Cancer Institute, Oregon Health and Science University, and Portland Veterans Affairs Medical Center, Portland, OR; Dana-Farber Cancer Institute and Harvard Cancer Center, Boston, MA; Fox-Chase Cancer Center, Philadelphia, PA; University of Turku, Turku; University of Helsinki, Helsinki, Finland; and Novartis Oncology, Basel, Switzerland
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McCall KC, Liu M, Cheng SC, Abbott A, Dubey S, Young D, Johnston M, Van den Abbeele AD, Overmoyer B, Jacene H. Report on the PET/CT Image-Based Radiation Dosimetry of [ 18F]FDHT in Women, a Validated Imaging Agent with New Applications for Evaluation of Androgen Receptor Status in Women with Metastatic Breast Cancer. J Nucl Med Technol 2023; 51:204-210. [PMID: 37316304 DOI: 10.2967/jnmt.123.265623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/21/2023] [Indexed: 06/16/2023] Open
Abstract
In a prospective clinical trial, [18F]fluoro-5α-dihydrotestosterone ([18F]FDHT), the radiolabeled analog of the androgen dihydrotestosterone, was used as a PET/CT imaging agent for in vivo assessment of metastatic androgen receptor-positive breast cancer in postmenopausal women. To our knowledge, this article presents the first report of PET/CT image-based radiation dosimetry of [18F]FDHT in women. Methods: [18F]FDHT PET/CT imaging was performed on a cohort of 11 women at baseline before the start of therapy and at 2 additional time points during selective androgen receptor modulator (SARM) therapy for androgen receptor-positive breast cancer. Volumes of interest (VOIs) were placed over the whole body and within source organs seen on the PET/CT images, and the time-integrated activity coefficients of [18F]FDHT were derived. The time-integrated activity coefficients for the urinary bladder were calculated using the dynamic urinary bladder model in OLINDA/EXM software, with biologic half-life for urinary excretion derived from VOI measurements of the whole body in postvoid PET/CT images. The time-integrated activity coefficients for all other organs were calculated from VOI measurements in the organs and the physical half-life of 18F. Organ dose and effective dose calculations were then performed using MIRDcalc, version 1.1. Results: At baseline before SARM therapy, the effective dose for [18F]FDHT in women was calculated as 0.020 ± 0.0005 mSv/MBq, and the urinary bladder was the organ at risk, with an average absorbed dose of 0.074 ± 0.011 mGy/MBq. Statistically significant decreases in liver SUV or uptake of [18F]FDHT were found at the 2 additional time points on SARM therapy (linear mixed model, P < 0.05). Likewise, absorbed dose to the liver also decreased by a small but statistically significant amount at the 2 additional time points (linear mixed model, P < 0.05). Neighboring abdominal organs of the gallbladder wall, stomach, pancreas, and adrenals also showed statistically significant decreases in absorbed dose (linear mixed model, P < 0.05). The urinary bladder wall remained the organ at risk at all time points. Absorbed dose to the urinary bladder wall did not show statistically significant changes from baseline at any of the time points (linear mixed model, P ≥ 0.05). Effective dose also did not show statistically significant changes from baseline (linear mixed model, P ≥ 0.05). Conclusion: Effective dose for [18F]FDHT in women before SARM therapy was calculated as 0.020 ± 0.0005 mSv/MBq. The urinary bladder wall was the organ at risk, with an absorbed dose of 0.074 ± 0.011 mGy/MBq.
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Affiliation(s)
- Keisha C McCall
- Department of Radiology, Henry Ford Health, Detroit, Michigan;
| | - Mofei Liu
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Su-Chun Cheng
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amanda Abbott
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shipra Dubey
- BiCOR, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Annick D Van den Abbeele
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Radiology, Mass General Brigham, Boston, Massachusetts; and
| | - Beth Overmoyer
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Heather Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Radiology, Mass General Brigham, Boston, Massachusetts; and
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Hicks RJ, Van den Abbeele AD. Will ultra-extended field-of-view scanners be an expensive folly or the next clinical standard for PET/CT? Cancer Imaging 2022; 22:49. [PMID: 36068626 PMCID: PMC9450327 DOI: 10.1186/s40644-022-00486-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Annick D Van den Abbeele
- Dana-Farber Cancer Institute and Mass General Brigham Hospitals, Harvard Medical School, Boston, MA, USA
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Jacobson FL, Van den Abbeele AD. Importance of 68Ga-FAPI PET/CT for Detection of Cancer. Radiology 2022; 303:200-201. [PMID: 34981981 DOI: 10.1148/radiol.212884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Francine L Jacobson
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (F.L.J., A.D.V.d.A.); and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (A.D.V.d.A.)
| | - Annick D Van den Abbeele
- From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (F.L.J., A.D.V.d.A.); and Department of Imaging, Dana-Farber Cancer Institute, Boston, Mass (A.D.V.d.A.)
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Van den Abbeele AD, Sakellis CG, George S. PET imaging of Gastrointestinal Stromal Tumors (GIST). Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00110-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Jacene HA, Liu M, Cheng SC, Abbott A, Dubey S, McCall K, Young D, Johnston M, Van den Abbeele AD, Overmoyer B. Imaging Androgen Receptors in Breast Cancer with 18F-fluoro-5α-dihydrotestosterone-PET: A Pilot Study. J Nucl Med 2021; 63:22-28. [PMID: 34049982 DOI: 10.2967/jnumed.121.262068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
Most breast cancers express androgen receptors (AR). This prospective imaging sub-study explored imaging AR with 18F-fluoro-5α-dihydrotestosterone (FDHT)-PET in patients with metastatic breast cancer (MBC) receiving selective AR modulation (SARM) therapy (GTx-024, GTx, Inc). Methods: 11 post-menopausal women with estrogen receptor positive MBC underwent FDHT-PET/CT at baseline, 6, and 12 weeks after starting SARM therapy. Abnormal tumor FDHT uptake was quantified using maximum SUV (SUVmax). AR status was determined from tumor biopsy specimens. FDHT-SUVmax percent change between scans was calculated. Best overall response was categorized as clinical benefit (CB: non-progressive disease [PD]), or PD using RECIST 1.1. Results: Median baseline FDHT-SUVmax was 4.1 (range 1.4-5.9) for AR+ tumors versus 2.3 (range 1.5-3.2) for AR- tumors (p=0.22). Quantitative AR expression and baseline FDHT uptake were weakly correlated (Pearson rho=0.39, p=0.30). Seven participants with CB at 12 weeks tended to have larger declines in FDHT uptake compared to those with PD at both 6 (median decline, range: -26.8%, -42.9 to -14.1% vs. -3.7%, -31% to +29%, respectively, p=0.11) and 12 weeks (median decline, range: -35.7%, -69.5 to -7.7% vs. -20.1%, -26.6% to +56.5%, respectively, p=0.17) after starting GTx-024. Conclusion: This hypothesis-generating data suggests that FDHT-PET/CT is worth further study as an imaging biomarker for evaluating response of MBC to SARM therapy and reiterates the feasibility of including molecular imaging in multidisciplinary therapeutic trials.
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Affiliation(s)
| | - Mofei Liu
- Dana-Farber Cancer Institute, United States
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Abstract
Theranostics is a precision medicine discipline that integrates diagnostic nuclear medicine imaging with radionuclide therapy in a manner that provides both a tumor phenotype and personalized therapy to patients with cancer using radiopharmaceuticals aimed at the same target-specific biological pathway or receptor. The aim of quantitative nuclear medicine imaging is to plan the alpha or beta-emitting therapy based on an accurate 3-dimensional representation of the in-vivo distribution of radioactivity concentration within the tumor and normal organs/tissues in a noninvasive manner. In general, imaging may be either based on positron emission tomography (PET) or single photon emission computed tomography (SPECT) invariably in combination with X-ray CT (PET/CT; SPECT/CT) or, to a much lesser extent, MRI. PET and SPECT differ in terms of the radionuclides and physical processes that give rise to the emission of high energy photons, as well as the sets of technologies involved in their detection. Using a variety of standardized quantitative parameters, system calibration, patient preparation, imaging acquisition and reconstruction protocols, and image analysis protocols, an accurate quantification of the tracer distribution can be obtained, which helps prescribe the therapeutic dose for each patient.
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Affiliation(s)
- Arda Könik
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA.
| | - Joseph A O'Donoghue
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard L Wahl
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St. Louis, MO
| | - Michael M Graham
- Past Director of Nuclear Medicine, Roy J and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Annick D Van den Abbeele
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Division of Cancer Imaging, Mass General Brigham, Boston, MA; Dana-Farber Cancer Institute and Mass General Brigham, Boston, MA; Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, MA; Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center, Boston, MA
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Abousaway O, Rakhshandehroo T, Van den Abbeele AD, Kircher MF, Rashidian M. Noninvasive Imaging of Cancer Immunotherapy. Nanotheranostics 2021; 5:90-112. [PMID: 33391977 PMCID: PMC7738948 DOI: 10.7150/ntno.50860] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
Immunotherapy has revolutionized the treatment of several malignancies. Notwithstanding the encouraging results, many patients do not respond to treatments. Evaluation of the efficacy of treatments is challenging and robust methods to predict the response to treatment are not yet available. The outcome of immunotherapy results from changes that treatment evokes in the tumor immune landscape. Therefore, a better understanding of the dynamics of immune cells that infiltrate into the tumor microenvironment may fundamentally help in addressing this challenge and provide tools to assess or even predict the response. Noninvasive imaging approaches, such as PET and SPECT that provide whole-body images are currently seen as the most promising tools that can shed light on the events happening in tumors in response to treatment. Such tools can provide critical information that can be used to make informed clinical decisions. Here, we review recent developments in the field of noninvasive cancer imaging with a focus on immunotherapeutics and nuclear imaging technologies and will discuss how the field can move forward to address the challenges that remain unresolved.
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Affiliation(s)
- Omar Abousaway
- Department of Imaging, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02215, USA
| | - Taha Rakhshandehroo
- Department of Imaging, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02215, USA
| | - Annick D Van den Abbeele
- Department of Imaging, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA
| | - Moritz F Kircher
- Department of Imaging, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA
| | - Mohammad Rashidian
- Department of Imaging, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02215, USA
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von Mehren M, George S, Heinrich MC, Schuetze SM, Yap JT, Yu JQ, Abbott A, Litwin S, Crowley J, Belinsky M, Janeway KA, Hornick JL, Flieder DB, Chugh R, Rink L, Van den Abbeele AD. Linsitinib (OSI-906) for the Treatment of Adult and Pediatric Wild-Type Gastrointestinal Stromal Tumors, a SARC Phase II Study. Clin Cancer Res 2020; 26:1837-1845. [PMID: 31792037 PMCID: PMC7856429 DOI: 10.1158/1078-0432.ccr-19-1069] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/03/2019] [Accepted: 11/22/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Most gastrointestinal stromal tumors (GIST) have activating mutations of KIT, PDGFRA, or uncommonly BRAF. Fifteen percent of adult and 85% of pediatric GISTs are wild type (WT), commonly having high expression of IGF-1R and loss of succinate dehydrogenase (SDH) complex function. We tested the efficacy of linsitinib, an oral TKI IGF-1R inhibitor, in patients with WT GIST. PATIENTS AND METHODS A multicenter phase II trial of linsitinib was conducted. The primary endpoint was objective response rate. Secondary endpoints were clinical benefit rate: complete response, partial response, and stable disease (SD) ≥ 9 months, and quantitative 2[18F]fluoro-2-deoxy-D-glucose (FDG) metabolic response (MR) at week 8. Serum levels for glucose, insulin, IGF-1R ligand IGF1, and binding proteins were obtained to explore correlations to patient outcomes and FDG-PET results. RESULTS Twenty patients were accrued in a 6-month period. Grade 3-4 toxicities possibly related to linsitinib were uncommon (8.5%). No objective responses were seen. Clinical benefit rate (CBR) at 9 months was 40%. Intense FDG uptake was observed at baseline, with partial MR of 12% and stable metabolic disease of 65% at week 8; these patients had RECIST 1.1 SD as their best response. Progression-free survival (PFS) and overall survival Kaplan-Meier estimates at 9 months were 52% and 80%, respectively. SDHA/B loss determined by IHC was seen in 35% and 88% of cases, respectively. CONCLUSIONS Linsitinib is well tolerated in patients with WT GIST. Although the 9-month CBR was 40%, and PFS at 9 months was 52%, no objective responses were observed. Rapid accrual to this study demonstrates that clinical trials of experimental agents in selected subtypes of GIST are feasible.
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Affiliation(s)
| | | | - Michael C Heinrich
- Portland VA Health Care System and OHSU Knight Cancer Institute, Portland, Oregon
| | | | - Jeffrey T Yap
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jain Q Yu
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | | | - John Crowley
- Cancer Research and Biostatistics, Seattle, Washington
| | | | | | - Jason L Hornick
- Harvard Medical School, Boston, Massachusetts
- Brigham Health, Boston, Massachusetts
| | | | - Rashmi Chugh
- University of Michigan, Ann Arbor, Michigan
- Sarcoma Alliance for Research through Collaboration, Ann Arbor, Michigan
| | - Lori Rink
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Annick D Van den Abbeele
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Brigham Health, Boston, Massachusetts
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Kim KW, Van den Abbeele AD. Evolution of Transarterial Chemoembolization for the Treatment of Liver Cancer. Radiology 2019; 293:704-706. [PMID: 31617799 PMCID: PMC6900203 DOI: 10.1148/radiol.2019192090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Kyung Won Kim
- From the Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu Seoul 138-736, Republic of Korea (K.W.K.); and Department of Imaging and Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute; Department of Radiology, Brigham Health, Harvard Medical School, Boston, Mass (A.D.V.d.A.)
| | - Annick D. Van den Abbeele
- From the Department of Radiology and Research Institute of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu Seoul 138-736, Republic of Korea (K.W.K.); and Department of Imaging and Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute; Department of Radiology, Brigham Health, Harvard Medical School, Boston, Mass (A.D.V.d.A.)
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Abbott A, Sakellis CG, Andersen E, Kuzuhara Y, Gilbert L, Boyle K, Kulke MH, Chan JA, Jacene HA, Van den Abbeele AD. Guidance on 177Lu-DOTATATE Peptide Receptor Radionuclide Therapy from the Experience of a Single Nuclear Medicine Division. J Nucl Med Technol 2018; 46:237-244. [DOI: 10.2967/jnmt.118.209148] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/18/2018] [Indexed: 11/16/2022] Open
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Protti A, Jones KL, Bonal DM, Qin L, Politi LS, Kravets S, Nguyen QD, Van den Abbeele AD. Development and validation of a new MRI simulation technique that can reliably estimate optimal in vivo scanning parameters in a glioblastoma murine model. PLoS One 2018; 13:e0200611. [PMID: 30036367 PMCID: PMC6056046 DOI: 10.1371/journal.pone.0200611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) relies on optimal scanning parameters to achieve maximal signal-to-noise ratio (SNR) and high contrast-to-noise ratio (CNR) between tissues resulting in high quality images. The optimization of such parameters is often laborious, time consuming, and user-dependent, making harmonization of imaging parameters a difficult task. In this report, we aim to develop and validate a computer simulation technique that can reliably provide "optimal in vivo scanning parameters" ready to be used for in vivo evaluation of disease models. METHODS A glioblastoma murine model was investigated using several MRI imaging methods. Such MRI methods underwent a simulated and an in vivo scanning parameter optimization in pre- and post-contrast conditions that involved the investigation of tumor, brain parenchyma and cerebrospinal fluid (CSF) CNR values in addition to the time relaxation values of the related tissues. The CNR tissues information were analyzed and the derived scanning parameters compared in order to validate the simulated methodology as a reliable technique for "optimal in vivo scanning parameters" estimation. RESULTS The CNRs and the related scanning parameters were better correlated when spin-echo-based sequences were used rather than the gradient-echo-based sequences due to augmented inhomogeneity artifacts affecting the latter methods. "Optimal in vivo scanning parameters" were generated successfully by the simulations after initial scanning parameter adjustments that conformed to some of the parameters derived from the in vivo experiment. CONCLUSION Scanning parameter optimization using the computer simulation was shown to be a valid surrogate to the in vivo approach in a glioblastoma murine model yielding in a better delineation and differentiation of the tumor from the contralateral hemisphere. In addition to drastically reducing the time invested in choosing optimal scanning parameters when compared to an in vivo approach, this simulation program could also be used to harmonize MRI acquisition parameters across scanners from different vendors.
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Affiliation(s)
- Andrea Protti
- Department of Imaging, Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Kristen L. Jones
- Department of Imaging, Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dennis M. Bonal
- Department of Imaging, Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lei Qin
- Department of Imaging, Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Letterio S. Politi
- Neuroimaging Research, Radiology Department, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Radiology Department, University of Massachusetts Medical School, Worcester, MA, United States of America
- University of Massachusetts Memorial Medical Center, Worcester, MA, United States of America
| | - Sasha Kravets
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Quang-Dé Nguyen
- Department of Imaging, Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Annick D. Van den Abbeele
- Department of Imaging, Lurie Family Imaging Center, Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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13
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Urban T, Ziegler E, Lewis R, Hafey C, Sadow C, Van den Abbeele AD, Harris GJ. LesionTracker: Extensible Open-Source Zero-Footprint Web Viewer for Cancer Imaging Research and Clinical Trials. Cancer Res 2017; 77:e119-e122. [PMID: 29092955 DOI: 10.1158/0008-5472.can-17-0334] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/01/2017] [Accepted: 08/03/2017] [Indexed: 12/28/2022]
Abstract
Oncology clinical trials have become increasingly dependent upon image-based surrogate endpoints for determining patient eligibility and treatment efficacy. As therapeutics have evolved and multiplied in number, the tumor metrics criteria used to characterize therapeutic response have become progressively more varied and complex. The growing intricacies of image-based response evaluation, together with rising expectations for rapid and consistent results reporting, make it difficult for site radiologists to adequately address local and multicenter imaging demands. These challenges demonstrate the need for advanced cancer imaging informatics tools that can help ensure protocol-compliant image evaluation while simultaneously promoting reviewer efficiency. LesionTracker is a quantitative imaging package optimized for oncology clinical trial workflows. The goal of the project is to create an open source zero-footprint viewer for image analysis that is designed to be extensible as well as capable of being integrated into third-party systems for advanced imaging tools and clinical trials informatics platforms. Cancer Res; 77(21); e119-22. ©2017 AACR.
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Affiliation(s)
- Trinity Urban
- Open Health Imaging Foundation, Chicago, Illinois.,Massachusetts General Hospital, Imaging Department, Boston, Massachusetts.,Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.,Precision Imaging Metrics, Boston, Massachusetts
| | - Erik Ziegler
- Open Health Imaging Foundation, Chicago, Illinois
| | - Rob Lewis
- Open Health Imaging Foundation, Chicago, Illinois
| | - Chris Hafey
- Open Health Imaging Foundation, Chicago, Illinois
| | - Cheryl Sadow
- Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.,Precision Imaging Metrics, Boston, Massachusetts.,Brigham and Women's Hospital, Imaging Department, 75 Francis Street, Boston, Massachusetts
| | - Annick D Van den Abbeele
- Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.,Precision Imaging Metrics, Boston, Massachusetts.,Dana-Farber Cancer Institute, Imaging Department, Boston, Massachusetts.,Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gordon J Harris
- Open Health Imaging Foundation, Chicago, Illinois. .,Massachusetts General Hospital, Imaging Department, Boston, Massachusetts.,Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts.,Precision Imaging Metrics, Boston, Massachusetts
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14
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Alabed YZ, Cheng SC, Mudge C, Sakellis C, Van den Abbeele AD, Campos SM, Jacene HA. Surveillance Imaging in Patients With Endometrial Cancer in First Remission. Curr Probl Diagn Radiol 2017; 47:311-316. [PMID: 28917433 DOI: 10.1067/j.cpradiol.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/09/2017] [Accepted: 08/21/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The clinical benefit of surveillance imaging in endometrial cancer remains undefined. This retrospective study was conducted to evaluate the positive predictive value (PPV) of surveillance imaging in endometrial cancer. METHODS A total of 128 patients in first remission after treatment for endometrial cancer (uterine papillary serous, clear cell, stage III endometroid) who had surveillance imaging were retrospectively identified. The surveillance period was defined from the time of first-negative scan after treatment to the time when treatment was started for recurrent disease. Reports of surveillance scans were reviewed for the presence or absence of findings. The primary outcome was PPV of surveillance imaging. Cost and radiation exposure from surveillance imaging were also evaluated. RESULTS A total of 128 patients had 707 surveillance scans (computed tomography, positron emission tomography-computed tomography with 2-deoxy-2-[18F]fluoro-d-glucose, magnetic resonance image, and bone scans). Median follow-up was 54 months (range: 9-173). Of all, 47 patients (37%) started therapy for recurrent endometrial cancer at the discretion of the treating physician. PPV of all surveillance imaging was 57.7%. Per patient, the mean number of surveillance scans was 5.6 (range: 2-21). The mean cost of imaging was $4200 (range: $1200-$18,700) and mean radiation exposure was 109.6mSV (range: 16-445mSv). CONCLUSIONS Surveillance imaging detected a significant number of recurrences in patients with high-risk endometrial cancer at a reasonable cost related to the overall risk. Well-designed prospective imaging trials are warranted to assess the clinical benefit of surveillance imaging.
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Affiliation(s)
- Yazan Z Alabed
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - Su-Chun Cheng
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Christopher Mudge
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Christopher Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Annick D Van den Abbeele
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Susana M Campos
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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15
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Shields AF, Jacobs PM, Sznol M, Graham MM, Germain RN, Lum LG, Jaffee EM, de Vries EGE, Nimmagadda S, Van den Abbeele AD, Leung DK, Wu AM, Sharon E, Shankar LK. Immune Modulation Therapy and Imaging: Workshop Report. J Nucl Med 2017; 59:410-417. [PMID: 28818991 DOI: 10.2967/jnumed.117.195610] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/11/2017] [Indexed: 12/26/2022] Open
Abstract
A workshop at the National Cancer Institute on May 2, 2016, considered the current state of imaging in assessment of immunotherapy. Immunotherapy has shown some remarkable and prolonged responses in the treatment of tumors. However, responses are variable and frequently delayed, complicating the evaluation of new immunotherapy agents and customizing treatment for individual patients. Early anatomic imaging may show that a tumor has increased in size, but this could represent pseudoprogression. On the basis of imaging, clinicians must decide if they should stop, pause, or continue treatment. Other imaging technologies and approaches are being developed to improve the measurement of response in patients receiving immunotherapy. Imaging methods that are being evaluated include radiomic methods using CT, MRI, and 18F-FDG PET, as well as new radiolabeled small molecules, antibodies, and antibody fragments to image the tumor microenvironment, immune status, and changes over the course of therapy. Current studies of immunotherapy can take advantage of these available imaging options to explore and validate their use. Collection of CT, PET, and MR images along with outcomes from trials is critical to develop improved methods of assessment.
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Affiliation(s)
- Anthony F Shields
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan .,National Cancer Institute, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | - Annick D Van den Abbeele
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Anna M Wu
- Crump Institute for Molecular Imaging, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Elad Sharon
- National Cancer Institute, Bethesda, Maryland
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16
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Krajewski KM, Howard SA, Shinagare AB, Van den Abbeele AD, Fennessy FM. Cancer Imaging Fellowship Training: Utility and Added Value in the Modern Era. J Am Coll Radiol 2017; 14:1345-1348. [PMID: 28697959 DOI: 10.1016/j.jacr.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Katherine M Krajewski
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; and the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Stephanie A Howard
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; and the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Atul B Shinagare
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; and the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Annick D Van den Abbeele
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; and the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fiona M Fennessy
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; and the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Shinagare AB, Suh CH, Kim KW, Somarouthu B, Van den Abbeele AD, Ramaiya NH. Ovarian Cancer: An Evidence-Based, Easy-to-Use Prediction Rule to Optimize the Use of Follow-up Chest CT. J Am Coll Radiol 2016; 14:499-508. [PMID: 27720583 DOI: 10.1016/j.jacr.2016.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/05/2016] [Accepted: 08/15/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE To create and validate an evidence-based prediction rule to optimize use of follow-up chest CT for ovarian cancer. METHODS In this Institutional Review Board-approved retrospective study performed at two academic medical centers, electronic medical records from January through December 2013 at center 1 (USA) and January 2012 through December 2013 at center 2 (South Korea) were searched to identify consecutive chest CTs performed within 5 years of initial cytoreductive surgery in patients with pathologically proven ovarian cancer. Three separate study cohorts were created: cohort 1, 316 CTs (in 150 patients) with high-grade serous ovarian cancer (HGSC) from center 1; cohort 2, 374 CTs (81 patients) with HGSC from center 2; and cohort 3, 87 CTs (56 patients) with non-HGSC histologies from center 1. A radiologist blinded to outcome of CT, using a prediction rule that utilized previously available information, categorized each CT into "high-risk" (stage 4 at presentation and/or preexisting abdominal disease [disease below diaphragmatic dome, visualized on abdominal CT]) or "low-risk" (neither of above). A blinded radiologist then reviewed chest CTs in random order to record thoracic metastases above the diaphragmatic dome, and outcome was compared with prediction rule risk category. RESULTS Among the three cohorts and in the total population, the prediction rule identified 94 of 316 (30%), 170 of 374 (45%), 53 of 87 (61%), and 317 of 777 (41%) CTs as "low-risk," respectively. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were as follows: cohort 1: 95%, 35%, 24%, 97%, 1.46, 0.14; cohort 2: 88%, 53%, 29%, 95%, 1.87, 0.22; cohort 3: 88%, 66%, 21%, 98%, 2.59, 0.18; total population: 91%, 47%, 26%, 96%, 1.72, 0.19. False-negative rate in the three cohorts and in total population was 3 of 94 (3%), 8 of 170 (5%), 1 of 53 (2%), and 12 of 317 (4%); however, in each of these cases there was concurrent new abdominal disease. CONCLUSIONS The easy-to-use prediction rule helps avoid unnecessary chest CTs in patients with ovarian cancer with high sensitivity and negative predictive value, and with minimal risk of missing thoracoabdominal metastases.
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Affiliation(s)
- Atul B Shinagare
- Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; Department of Radiology, Namwon Medical Center, Jeollabuk-Do, South Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Bhanusupriya Somarouthu
- Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Annick D Van den Abbeele
- Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Nikhil H Ramaiya
- Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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18
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O'Neill AF, Qin L, Wen PY, de Groot JF, Van den Abbeele AD, Yap JT. Demonstration of DCE-MRI as an early pharmacodynamic biomarker of response to VEGF Trap in glioblastoma. J Neurooncol 2016; 130:495-503. [PMID: 27576699 DOI: 10.1007/s11060-016-2243-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/20/2016] [Indexed: 01/18/2023]
Abstract
Glioblastoma (GBM) is an incurable brain tumor characterized by the expression of pro-angiogenic cytokines. A recent phase II clinical trial studied VEGF Trap in adult patients with temozolomide-resistant GBM. We sought to explore changes in [18F]Fluorodeoxyglucose positron emission tomography (FDG-PET) or magnetic resonance imaging (MRI) in trial participants correlating these changes with disease response. FDG-PET and MRI images obtained before and after the first dose of VEGF Trap were spatially co-registered. Regions of interest on each image slice were combined to produce a volume of interest representative of the entire tumor. Percent and absolute changes in maximum FDG-avidity, mean apparent diffusion coefficient (ADC), Ktrans, and Ve were calculated per lesion. Among the 12 participants that underwent dynamic contrast enhanced MRI (DCE-MRI), there were large, statistically significant reductions in Ktrans and Ve (median difference = -41.8 %, p < 0.02 and -42.6 %, p < 0.04, respectively). In contrast, there were no significant reductions in ADC or FDG-PET SUVmax values. DCE-MRI is a useful measure of early pharmacodynamic effects of VEGF Trap on tumor vasculature. The absence of significant changes in FDG-PET and DW-MRI suggest that the early pharmacodynamic effects are specific to tumor perfusion and/or permeability and do not directly inhibit metabolism or induce cell death. DCE-MRI in conjunction with standard imaging may be promising for the identification of anti-angiogenic effects in this patient population with this therapeutic target. Further studies are needed to evaluate the relationship between DCE-MRI response and clinical outcome.
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Affiliation(s)
- Allison F O'Neill
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02215, USA.
| | - Lei Qin
- Department of Imaging and Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, MA, 02115, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Patrick Y Wen
- Center for Neuro-oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - John F de Groot
- The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Annick D Van den Abbeele
- Department of Imaging and Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, MA, 02115, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Jeffrey T Yap
- Department of Radiology, Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA
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19
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O'Neill AC, Somarouthu B, Tirumani SH, Braschi-Amirfarzan M, Van den Abbeele AD, Ramaiya NH, Shinagare AB. Patterns and Prognostic Importance of Hepatic Involvement in Patients with Serous Ovarian Cancer: A Single-Institution Experience with 244 Patients. Radiology 2016; 282:160-170. [PMID: 27479640 DOI: 10.1148/radiol.2016152595] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the frequency, patterns, and prognostic importance of metastatic hepatic involvement in serous ovarian cancer. Materials and Methods This institutional review board-approved retrospective study, with waived informed consent, included 244 patients with pathologically proven serous ovarian cancer (mean age ± standard deviation, 59 years ± 10.7; range 19-93 years). Electronic medical records and all available imaging studies over a median follow-up of 44 months (interquartile range [IQR], 27-70) were reviewed to identify the frequency of liver parenchymal invasion (LPI) from perihepatic peritoneal metastasis and hematogenous liver metastases. The associations and prognostic importance of LPI and hematogenous metastases were studied by using univariate and multivariate Cox proportional analysis. Results Eighty-four of 244 patients (34%) developed perihepatic metastases, of whom 55 (23%) developed LPI after median of 43 months (IQR, 25-63). Hematogenous hepatic metastases developed in 38 of 244 patients (16%) after median of 42 months (IQR, 26-64). At multivariate analysis, age (P = .008; hazard ratio [HR]: 1.03; 95% confidence interval [CI]: 1.009, 1.07) and suboptimal cytoreduction (P = .03; HR, 2.13; 95% CI: 1.12, 4.07) were associated with LPI. Increasing age (P = .01; HR, 1.04; 95% CI: 1.008, 1.08), high-grade tumor (P = .01; HR, 6.75; 95% CI: 1.44, 120.5), and advanced stage (P = .03; HR, 3.16; 95% CI: 1.94, 4.56) were associated with hematogenous metastases. Overall survival with and without LPI was similar (median, 80 months; IQR, 50-not reached vs 123 months; IQR, 49-279; P = .6). Hematogenous metastases were associated with significantly shorter survival at univariate (median 63 months, IQR 43-139 vs 145 months, IQR 50-not reached; P = .006) and multivariate analyses (P = .03; HR, 1.88; 95% CI: 1.14, 3.28). Conclusion Differentiating hematogenous metastases and LPI is important for radiologists; hematogenous metastases are associated with shorter survival, while LPI does not adversely affect survival and prognostically behaves like peritoneal disease. © RSNA, 2016.
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Affiliation(s)
- Ailbhe C O'Neill
- From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115
| | - Bhanusupriya Somarouthu
- From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115
| | - Sree Harsha Tirumani
- From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115
| | - Marta Braschi-Amirfarzan
- From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115
| | - Annick D Van den Abbeele
- From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115
| | - Nikhil H Ramaiya
- From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115
| | - Atul B Shinagare
- From the Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115
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20
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Kwak JJ, Tirumani SH, Van den Abbeele AD, Koo PJ, Jacene HA. Cancer immunotherapy: imaging assessment of novel treatment response patterns and immune-related adverse events. Radiographics 2016; 35:424-37. [PMID: 25763727 DOI: 10.1148/rg.352140121] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Cancer immunotherapy is changing the imaging evaluation of cancer treatment response and treatment-related toxic effects. New emerging patterns of treatment response and treatment-related toxic effects after treatment with immunomodulating agents have been observed. Treatment response after immunomodulatory therapy can be associated with significantly delayed decrease in tumor size, and new or enlarging tumors observed soon after completion of treatment may not reflect disease progression. In addition, activation of the immune system to fight cancer may lead to unwanted autoimmune-mediated toxic effects that could be mistaken for metastatic disease or misdiagnosed as a non-treatment-related process and delay appropriate clinical management. Radiologists must recognize the novel treatment response patterns and the wide range of autoimmune toxic effects, which should not be mistaken for treatment failure or metastatic disease progression.
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Affiliation(s)
- Jennifer J Kwak
- From the Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, 12700 E 19th Ave, Room C278, Aurora, CO 80045 (J.J.K., P.J.K.); and Department of Imaging, Dana-Farber Cancer Institute, and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.H.T., A.D.V.d.A., H.A.J.)
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21
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Van den Abbeele AD, Krajewski KM, Tirumani SH, Fennessy FM, DiPiro PJ, Nguyen QD, Harris GJ, Jacene HA, Lefever G, Ramaiya NH. Cancer Imaging at the Crossroads of Precision Medicine: Perspective From an Academic Imaging Department in a Comprehensive Cancer Center. J Am Coll Radiol 2016; 13:365-71. [PMID: 26774886 DOI: 10.1016/j.jacr.2015.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 09/30/2022]
Abstract
The authors propose one possible vision for the transformative role that cancer imaging in an academic setting can play in the current era of personalized and precision medicine by sharing a conceptual model that is based on experience and lessons learned designing a multidisciplinary, integrated clinical and research practice at their institution. The authors' practice and focus are disease-centric rather than imaging-centric. A "wall-less" infrastructure has been developed, with bidirectional integration of preclinical and clinical cancer imaging research platforms, enabling rapid translation of novel cancer drugs from discovery to clinical trial evaluation. The talents and expertise of medical professionals, scientists, and staff members have been coordinated in a horizontal and vertical fashion through the creation of Cancer Imaging Consultation Services and the "Adopt-a-Radiologist" campaign. Subspecialized imaging consultation services at the hub of an outpatient cancer center facilitate patient decision support and management at the point of care. The Adopt-a-Radiologist campaign has led to the creation of a novel generation of imaging clinician-scientists, fostered new collaborations, increased clinical and academic productivity, and improved employee satisfaction. Translational cancer research is supported, with a focus on early in vivo testing of novel cancer drugs, co-clinical trials, and longitudinal tumor imaging metrics through the imaging research core laboratory. Finally, a dedicated cancer imaging fellowship has been developed, promoting the future generation of cancer imaging specialists as multidisciplinary, multitalented professionals who are trained to effectively communicate with clinical colleagues and positively influence patient care.
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Affiliation(s)
- Annick D Van den Abbeele
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Katherine M Krajewski
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Sree Harsha Tirumani
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Fiona M Fennessy
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Pamela J DiPiro
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Quang-Dé Nguyen
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts; Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gordon J Harris
- Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Greg Lefever
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nikhil H Ramaiya
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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Shinagare AB, O’Neill AC, Cheng S, Somarouthu B, Tirumani SH, Nishino M, Van den Abbeele AD, Ramaiya NH. Advanced High-Grade Serous Ovarian Cancer: Frequency and Timing of Thoracic Metastases and the Implications for Chest Imaging Follow-up. Radiology 2015; 277:733-740. [DOI: 10.1148/radiol.2015142467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Buchbinder EI, Sosman JA, Lawrence DP, McDermott DF, Ramaiya NH, Van den Abbeele AD, Linette GP, Giobbie-Hurder A, Hodi FS. Phase 2 study of sunitinib in patients with metastatic mucosal or acral melanoma. Cancer 2015; 121:4007-15. [PMID: 26264378 DOI: 10.1002/cncr.29622] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/06/2015] [Accepted: 06/15/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Patients with mucosal and acral melanomas have limited treatment options and a poor prognosis. Mutations of the KIT oncogene in these melanoma subtypes provide a potential therapeutic target. METHODS A multicenter phase 2 trial of sunitinib was conducted in patients with unresectable stage III or IV melanoma of a mucosal or acral primary origin. Patients were treated in 2 cohorts: cohort A received sunitinib at a dose of 50 mg daily for 4 weeks of a 6-week cycle, and cohort B received sunitinib at a dose of 37.5 mg daily on a continuous basis. Dose reductions were permitted for treatment-related toxicities, and tumor assessments were performed every 2 months. RESULTS Fifty-two patients were enrolled: 21 in cohort A and 31 in cohort B. Four patients had confirmed partial responses, which lasted 5 to 10 months (1 with a KIT mutation). In both cohorts, the proportion of patients alive and progression-free at 2 months was 52% (95% confidence interval, 38%-66%); this was significantly larger than the hypothesized null of 5%. There was no significant difference in response or overall survival between the 25% of patients with a KIT mutation and those without one (response rate, 7.7% vs 9.7%; overall survival, 6.4 vs 8.6 months). The overall disease control rate was 44%, and a high rate of toxicity was associated with the treatment. CONCLUSIONS Sunitinib showed activity in the treatment of mucosal and acral melanoma that was not dependent on the presence of a KIT mutation. However, the medication was poorly tolerated, and there were no prolonged responses. Cancer 2015;121:4007-4015. © 2015 American Cancer Society.
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Affiliation(s)
| | - Jeffrey A Sosman
- Hematology-Oncology, Vanderbilt University, Nashville, Tennessee
| | - Donald P Lawrence
- Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - David F McDermott
- Hematology-Oncology, Beth Israel-Deaconess Medical Center, Boston, Massachusetts
| | - Nikhil H Ramaiya
- Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Annick D Van den Abbeele
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gerald P Linette
- Hematology-Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Anita Giobbie-Hurder
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Lin NU, Guo H, Yap JT, Mayer IA, Falkson CI, Hobday TJ, Dees EC, Richardson AL, Nanda R, Rimawi MF, Ryabin N, Najita JS, Barry WT, Arteaga CL, Wolff AC, Krop IE, Winer EP, Van den Abbeele AD. Phase II Study of Lapatinib in Combination With Trastuzumab in Patients With Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer: Clinical Outcomes and Predictive Value of Early [18F]Fluorodeoxyglucose Positron Emission Tomography Imaging (TBCRC 003). J Clin Oncol 2015; 33:2623-31. [PMID: 26169615 DOI: 10.1200/jco.2014.60.0353] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Lapatinib plus trastuzumab improves outcomes relative to lapatinib alone in heavily pretreated, human epidermal growth factor receptor 2-positive metastatic breast cancer (MBC). We tested the combination in the earlier-line setting and explored the predictive value of [(18)F]fluorodeoxyglucose positron emission tomography ([(18)F]FDG-PET) for clinical outcomes. PATIENTS AND METHODS Two cohorts were enrolled (cohort 1: no prior trastuzumab for MBC and ≥ 1 year from adjuvant trastuzumab, if given; cohort 2: one to two lines of chemotherapy including trastuzumab for MBC and/or recurrence < 1 year from adjuvant trastuzumab). The primary end point was objective response rate by RECIST v1.0; secondary end points included clinical benefit rate (complete response plus partial response plus stable disease ≥ 24 weeks) and progression-free survival. [(18)F]FDG-PET scans were acquired at baseline, week 1, and week 8. Associations between metabolic response and clinical outcomes were explored. RESULTS Eighty-seven patients were registered (85 were evaluable for efficacy). The confirmed objective response rate was 50.0% (95% CI, 33.8% to 66.2%) in cohort 1 and 22.2% (95% CI, 11.3% to 37.3%) in cohort 2. Clinical benefit rate was 57.5% (95% CI, 40.9% to 73.0%) in cohort 1 and 40.0% (95% CI, 25.7% to 55.7%) in cohort 2. Median progression-free survival was 7.4 and 5.3 months, respectively. Lack of week-1 [(18)F]FDG-PET/computed tomography ([(18)F]FDG-PET/CT) response was associated with failure to achieve an objective response by RECIST (negative predictive value, 91% [95% CI, 74% to 100%] for cohort 1 and 91% [95% CI, 79% to 100%] for cohort 2). CONCLUSION Early use of lapatinib and trastuzumab is active in human epidermal growth factor receptor 2-positive MBC. Week-1 [(18)F]FDG-PET/CT may allow selection of patients who can be treated with targeted regimens and spared the toxicity of chemotherapy.
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Affiliation(s)
- Nancy U Lin
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
| | - Hao Guo
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Jeffrey T Yap
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Ingrid A Mayer
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Carla I Falkson
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Timothy J Hobday
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - E Claire Dees
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Andrea L Richardson
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Rita Nanda
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Mothaffar F Rimawi
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Nicole Ryabin
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Julie S Najita
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - William T Barry
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Carlos L Arteaga
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Antonio C Wolff
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Ian E Krop
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Eric P Winer
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Annick D Van den Abbeele
- Nancy U. Lin, Hao Guo, Nicole Ryabin, Julie S. Najita, William T. Barry, Ian E. Krop, Eric P. Winer, and Annick D. Van den Abbeele, Dana-Farber Cancer Institute; Andrea L. Richardson and Annick D. Van den Abbeele, Brigham and Women's Hospital, Boston, MA; Jeffrey T. Yap, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Ingrid A. Mayer and Carlos L. Arteaga, Vanderbilt-Ingram Cancer Center, Nashville, TN; Carla I. Falkson, University of Alabama, Birmingham, AL; Timothy J. Hobday, Mayo Clinic, Rochester, MN; E. Claire Dees, University of North Carolina, Chapel Hill, NC; Rita Nanda, University of Chicago, Chicago, IL; Mothaffar F. Rimawi, Baylor College of Medicine, Houston, TX; and Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
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Howard SA, Krajewski KM, Weissman BN, Seltzer SE, Ramaiya NH, Van den Abbeele AD. Cancer Imaging Training in the 21st Century: An Overview of Where We Are, and Where We Need To Be. J Am Coll Radiol 2015; 12:714-20. [DOI: 10.1016/j.jacr.2015.03.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/27/2015] [Indexed: 12/22/2022]
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Zukotynski KA, Kim CK, Gerbaudo VH, Hainer J, Taplin ME, Kantoff P, den Abbeele ADV, Seltzer S, Sweeney CJ. (18)F-FDG-PET/CT and (18)F-NaF-PET/CT in men with castrate-resistant prostate cancer. Am J Nucl Med Mol Imaging 2014; 5:72-82. [PMID: 25625029 PMCID: PMC4299771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/03/2014] [Indexed: 06/04/2023]
Abstract
To evaluate (18)F-labeled-fluorodeoxyglucose ((18)F-FDG-) and (18)F-labeled-sodium fluoride ((18)F-NaF-) positron emission tomography/computed tomography (PET/CT) as biomarkers in metastatic castrate-resistant prostate cancer (mCRPC). Nine men (53-75 years) in a phase 1 trial of abiraterone and cabozantinib had (18)F-FDG-PET/CT, (18)F-NaF-PET/CT and standard imaging ((99m)Tc-labeled-methylene-diphosphonate ((99m)Tc-MDP) bone scan and abdominal/pelvic CT) at baseline and after 8 weeks of therapy. Baseline disease was classified as widespread (18)F-FDG-avid, oligometastatic (18)F-FDG-avid (1 site), or non-(18)F-FDG-avid. Metabolic response was classified using European Organisation for Research and Treatment of Cancer (EORTC) criteria. Treatment response using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, Prostate Cancer Working Group 2 (PCWG2) guidelines and days on trial (DOT) were recorded. All men were followed for 1 year or until progression. Four men had (18)F-FDG-avid disease: two with widespread (DOT 53 and 76) and two with oligometastatic disease (DOT 231 and still on trial after 742+ days). Five men had non-(18)F-FDG-avid disease; three remained stable or improved (2 still on trial while one discontinued for non-oncologic reasons; DOT 225-563+), and 2 progressed (DOT 285 and 532). Despite the small sample size, Kaplan-Meier analysis showed a significant difference in progression free survival (PFS) between men with widespread (18)F-FDG-avid, oligometastatic (18)F-FDG-avid and non-(18)F-FDG-avid disease (p < 0.01). All men had (18)F-NaF-avid disease. Neither (18)F-NaF-avid disease extent nor intensity was predictive of treatment response. (18)F-FDG-PET/CT may be superior to (18)F-NaF-PET/CT and standard imaging in men with mCRPC on abiraterone and cabozantinib. (18)F-FDG-PET/CT may have potential to stratify men into 3 groups (widespread vs. oligometastatic (18)F-FDG-avid vs. non-(18)F-FDG-avid mCRPC) to tailor therapy. Further evaluation is warranted.
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Affiliation(s)
- Katherine A Zukotynski
- Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, USA
- Dana-Farber Cancer Institute, Harvard Medical SchoolBoston, MA, USA
- Sunnybrook Health Sciences Centre, University of TorontoON, Canada
| | - Chun K Kim
- Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, USA
- Dana-Farber Cancer Institute, Harvard Medical SchoolBoston, MA, USA
| | | | - Jon Hainer
- Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, USA
| | | | - Philip Kantoff
- Dana-Farber Cancer Institute, Harvard Medical SchoolBoston, MA, USA
| | - Annick D Van den Abbeele
- Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, USA
- Dana-Farber Cancer Institute, Harvard Medical SchoolBoston, MA, USA
| | - Steven Seltzer
- Brigham and Women’s Hospital, Harvard Medical SchoolBoston, MA, USA
- Dana-Farber Cancer Institute, Harvard Medical SchoolBoston, MA, USA
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Zukotynski K, Yap JT, Giobbie-Hurder A, Weber J, Gonzalez R, Gajewski TF, O'Day S, Kim K, Hodi FS, Van den Abbeele AD. Metabolic response by FDG-PET to imatinib correlates with exon 11 KIT mutation and predicts outcome in patients with mucosal melanoma. Cancer Imaging 2014; 14:30. [PMID: 25609545 PMCID: PMC4331835 DOI: 10.1186/s40644-014-0030-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/01/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In patients with metastatic melanoma and KIT amplifications and/or mutations, therapy with imatinib mesylate may prolong survival. 18F-labeled 2-fluoro-2-deoxy-D-glucose (18F-FDG) PET/CT may be used to assess metabolic response. We investigated associations of metabolic response, mutational status, progression-free survival and overall survival in this population. METHODS Baseline and 4-week follow-up 18F-FDG-PET/CT were evaluated in 17 patients with metastatic melanoma and KIT amplifications and/or mutations treated with imatinib in a multicenter phase II clinical trial. The maximum standardized uptake values (SUVmax) were measured in up to 10 lesions on each scan. Metabolic response was classified using modified EORTC criteria. Each patient had a diagnostic CT or MR at baseline, after 6 weeks of therapy and then at intervals of 2 months and anatomic response was classified using RECIST 1.0. Median follow-up was 9.8 months. RESULTS Partial metabolic response (PMR), stable metabolic disease (SMD) and progressive metabolic disease (PMD) was seen in 5 (29%), 5 (29%), and 7 (41%) patients respectively. Five patients (29%) had a KIT mutation in exon 11, four of whom (80%) had PMR while 1 (20%) had SMD. Twelve patients (71%) did not have a KIT mutation in exon 11, and only 1 (8%) had PMR, 4 (33%) had SMD and 7 (58%) had PMD. There was agreement of metabolic and anatomic classification in 12 of 17 patients (71%). Four of 17 patients (24%) had PR on both metabolic and anatomic imaging and all had a KIT mutation in exon 11. Survival of patients with PMD was lower than with SMD or PMR. CONCLUSIONS Metabolic response by 18F-FDG-PET/CT is associated with mutational status in metastatic melanoma patients treated with imatinib. 18F-FDG-PET/CT may be a predictor of outcome, although a larger study is needed to verify this. CLINICAL TRIAL REGISTRATION NCT00424515.
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Courtney KD, Manola JB, Elfiky AA, Ross R, Oh WK, Yap JT, Van den Abbeele AD, Ryan CW, Beer TM, Loda M, Priolo C, Kantoff P, Taplin ME. A phase I study of everolimus and docetaxel in patients with castration-resistant prostate cancer. Clin Genitourin Cancer 2014; 13:113-23. [PMID: 25450031 DOI: 10.1016/j.clgc.2014.08.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/12/2014] [Accepted: 08/25/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The PTEN tumor suppressor is frequently lost in CRPC, with activation of Akt-mTOR signaling, driving growth. We conducted a phase I trial of the mTOR inhibitor, everolimus, and docetaxel in CRPC. PATIENTS AND METHODS Eligible patients had progressive, metastatic, chemotherapy-naive CRPC. Patients received everolimus 10 mg daily for 2 weeks and underwent a restaging FDG-PET/computed tomography scan. Patient cohorts were subsequently treated at 3 dose levels of everolimus with docetaxel: 5 mg to 60 mg/m(2), 10 mg to 60 mg/m(2), and 10 mg to 70 mg/m(2). The primary end point was the safety and tolerability of combination therapy. RESULTS Accrual was 4 patients at level 1, 3 patients at level 2, and 8 patients at level 3. Common toxicities were hematologic and fatigue. Serum concentrations of everolimus when administered with docetaxel were 1.5 to 14.8 ng/mL in patients receiving 5 mg everolimus and 4.5 to 55.4 ng/mL in patients receiving 10 mg everolimus. Four patients had partial metabolic response (PMR) using FDG-PET, 12 had stable metabolic disease, and 2 had progressive metabolic disease after a 2-week treatment with everolimus alone. Five of 12 evaluable patients experienced a prostate-specific antigen (PSA) reduction ≥ 50% during treatment with everolimus together with docetaxel. All 4 patients with a PMR according to PET imaging experienced a PSA reduction in response to everolimus with docetaxel, and 3 of 4 had PSA declines ≥ 50%. CONCLUSION Everolimus 10 mg daily and docetaxel 60 mg/m(2) was safe in CRPC patients and these were the recommended doses in combination. FDG-PET response might serve as a biomarker for target inhibition by mTOR inhibitors.
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Affiliation(s)
- Kevin D Courtney
- Medical Oncology, Dana-Farber Cancer Institute and Internal Medicine, Harvard Medical School, Boston, MA
| | - Judith B Manola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Aymen A Elfiky
- Medical Oncology, Dana-Farber Cancer Institute and Internal Medicine, Harvard Medical School, Boston, MA
| | - Robert Ross
- Medical Oncology, Dana-Farber Cancer Institute and Internal Medicine, Harvard Medical School, Boston, MA
| | - William K Oh
- Medical Oncology, Dana-Farber Cancer Institute and Internal Medicine, Harvard Medical School, Boston, MA
| | - Jeffrey T Yap
- Department of Imaging, Dana-Farber Cancer Institute, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Annick D Van den Abbeele
- Department of Imaging, Dana-Farber Cancer Institute, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Christopher W Ryan
- Knight Cancer Institute at Oregon Health and Science University, Portland, OR
| | - Tomasz M Beer
- Knight Cancer Institute at Oregon Health and Science University, Portland, OR
| | - Massimo Loda
- Medical Oncology, Dana-Farber Cancer Institute and Internal Medicine, Harvard Medical School, Boston, MA; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Carmen Priolo
- Medical Oncology, Dana-Farber Cancer Institute and Internal Medicine, Harvard Medical School, Boston, MA
| | - Philip Kantoff
- Medical Oncology, Dana-Farber Cancer Institute and Internal Medicine, Harvard Medical School, Boston, MA
| | - Mary-Ellen Taplin
- Medical Oncology, Dana-Farber Cancer Institute and Internal Medicine, Harvard Medical School, Boston, MA.
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Krajewski KM, Franchetti Y, Nishino M, Fay AP, Ramaiya N, Van den Abbeele AD, Choueiri TK. 10% Tumor diameter shrinkage on the first follow-up computed tomography predicts clinical outcome in patients with advanced renal cell carcinoma treated with angiogenesis inhibitors: a follow-up validation study. Oncologist 2014; 19:507-14. [PMID: 24755461 DOI: 10.1634/theoncologist.2013-0391] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Vascular endothelial growth factor (VEGF)-targeted agents are standard therapies for metastatic renal cell carcinoma (mRCC), associated with variable tumor shrinkage. Response Evaluation Criteria in Solid Tumors (RECIST) is of limited utility in this setting, and other imaging changes are sought to reliably predict outcome early. We aim to validate 10% tumor shrinkage as the best early indicator of outcome. Methods. In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study, 66 mRCC patients with 165 lesions on clinical trials of VEGF-targeted agents underwent thoracic and abdominal computed tomography at baseline and at first follow-up after therapy. Measurements were performed according to RECIST and tumor shrinkage of ≥10% decrease in sum of the longest diameter (-10%SLD). Correlation with time-to-treatment failure (TTF) and overall survival (OS) were compared and stratified by response to the radiologic criteria. Receiver-operating characteristics (ROC) analysis yielded the optimal threshold change in SLD, defining patients with prolonged survival. Results. More than -10%SLD significantly differentiated responders from nonresponders (median TTF 8.4 vs. 4.1 months, p = .001), whereas partial response by RECIST did not (median TTF 6.9 vs. 5.5 months in responders vs. nonresponders, p = .34). -10%SLD was also significantly predictive of OS (median OS 35.1 vs. 15.0 months in responders vs. nonresponders, p = .003). ROC curve analysis yielded -9.3% in SLD as the optimal threshold for response/no response. Conclusion. Ten percent tumor shrinkage is validated as a reliable early predictor of outcome in mRCC patients receiving VEGF-targeted therapies and may provide a practical measure to guide therapeutic decisions.
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Affiliation(s)
- Katherine M Krajewski
- Department of Imaging, Dana-Farber Cancer Institute, and Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA; Kidney Cancer Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Hodi FS, Lawrence D, Lezcano C, Wu X, Zhou J, Sasada T, Zeng W, Giobbie-Hurder A, Atkins MB, Ibrahim N, Friedlander P, Flaherty KT, Murphy GF, Rodig S, Velazquez EF, Mihm MC, Russell S, DiPiro PJ, Yap JT, Ramaiya N, Van den Abbeele AD, Gargano M, McDermott D. Bevacizumab plus ipilimumab in patients with metastatic melanoma. Cancer Immunol Res 2014; 2:632-42. [PMID: 24838938 DOI: 10.1158/2326-6066.cir-14-0053] [Citation(s) in RCA: 433] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ipilimumab improves survival in advanced melanoma and can induce immune-mediated tumor vasculopathy. Besides promoting angiogenesis, vascular endothelial growth factor (VEGF) suppresses dendritic cell maturation and modulates lymphocyte endothelial trafficking. This study investigated the combination of CTLA4 blockade with ipilimumab and VEGF inhibition with bevacizumab. Patients with metastatic melanoma were treated in four dosing cohorts of ipilimumab (3 or 10 mg/kg) with four doses at 3-week intervals and then every 12 weeks, and bevacizumab (7.5 or 15 mg/kg) every 3 weeks. Forty-six patients were treated. Inflammatory events included giant cell arteritis (n = 1), hepatitis (n = 2), and uveitis (n = 2). On-treatment tumor biopsies revealed activated vessel endothelium with extensive CD8(+) and macrophage cell infiltration. Peripheral blood analyses demonstrated increases in CCR7(+/-)/CD45RO(+) cells and anti-galectin antibodies. Best overall response included 8 partial responses, 22 instances of stable disease, and a disease-control rate of 67.4%. Median survival was 25.1 months. Bevacizumab influences changes in tumor vasculature and immune responses with ipilimumab administration. The combination of bevacizumab and ipilimumab can be safely administered and reveals VEGF-A blockade influences on inflammation, lymphocyte trafficking, and immune regulation. These findings provide a basis for further investigating the dual roles of angiogenic factors in blood vessel formation and immune regulation, as well as future combinations of antiangiogenesis agents and immune checkpoint blockade.
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Affiliation(s)
| | - Donald Lawrence
- Massachusetts General Hospital Cancer Center; Departments of
| | - Cecilia Lezcano
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Xinqi Wu
- Authors' Affiliations: Departments of Medical Oncology
| | - Jun Zhou
- Authors' Affiliations: Departments of Medical Oncology
| | | | - Wanyong Zeng
- Authors' Affiliations: Departments of Medical Oncology
| | | | - Michael B Atkins
- Lombardi Cancer Center Georgetown University, Washington, District of Columbia; and
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Gargano
- Authors' Affiliations: Departments of Medical Oncology
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Mayer IA, Abramson VG, Isakoff SJ, Forero A, Balko JM, Kuba MG, Sanders ME, Yap JT, Van den Abbeele AD, Li Y, Cantley LC, Winer E, Arteaga CL. Stand up to cancer phase Ib study of pan-phosphoinositide-3-kinase inhibitor buparlisib with letrozole in estrogen receptor-positive/human epidermal growth factor receptor 2-negative metastatic breast cancer. J Clin Oncol 2014; 32:1202-9. [PMID: 24663045 DOI: 10.1200/jco.2013.54.0518] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Buparlisib, an oral reversible inhibitor of all class I phosphoinositide-3-kinases, has shown antitumoral activity against estrogen receptor (ER)-positive breast cancer cell lines and xenografts, alone and with endocrine therapy. This phase Ib study evaluated buparlisib plus letrozole's safety, tolerability, and preliminary activity in patients with metastatic ER-positive breast cancer refractory to endocrine therapy. PATIENTS AND METHODS Patients received letrozole and buparlisib in two different administration schedules. Outcomes were assessed by standard solid-tumor phase I methods. [(18)F]fluorodeoxyglucose-positron emission tomography/computed tomography ([(18)F]FDG-PET/CT) scans were done at baseline and 2 weeks after treatment initiation. Tumor blocks were collected for phosphoinositide-3-kinase pathway mutation analysis. RESULTS Fifty-one patients were allocated sequentially to continuous or intermittent (five on/two off days) buparlisib administration on an every-4-week schedule. Buparlisib's maximum-tolerated dose (MTD) was 100 mg/d. Common drug-related adverse events included ≤ grade 2 hyperglycemia, nausea, fatigue, transaminitis, and mood disorders. The clinical benefit rate (lack of progression ≥ 6 months) among all patients treated at the MTD was 31%, including two objective responses in the continuous dose arm. Of seven patients remaining on treatment ≥ 12 months, three had tumors with PIK3CA hot-spot mutation. Patients exhibiting metabolic disease progression by [(18)F]FDG-PET/CT scan at 2 weeks progressed rapidly on therapy. CONCLUSION The letrozole and buparlisib combination was safe, with reversible toxicities regardless of schedule administration. Clinical activity was observed independent of PIK3CA mutation status. No metabolic response by [(18)F]FDG-PET/CT scan at 2 weeks was associated with rapid disease progression. Phase III trials of buparlisib and endocrine therapy in patients with ER-positive breast cancer are ongoing.
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Affiliation(s)
- Ingrid A Mayer
- Ingrid A. Mayer, Vandana G. Abramson, Justin M. Balko, María Gabriela Kuba, Melinda E. Sanders, and Carlos L. Arteaga, Vanderbilt University, Nashville, TN; Steven J. Isakoff, Massachusetts General Hospital, Boston, MA; Andres Forero, University of Alabama, Birmingham, AL; Jeffrey T. Yap, Huntsman Cancer Institute, Salt Lake City, UT; Annick D. Van den Abbeele and Eric Winer, Dana-Farber Cancer Institute, Boston, MA; Yisheng Li, MD Anderson Cancer Center, Houston, TX; and Lewis C. Cantley, Weill Cornell Medical College, New York, NY
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Guo M, Yap JT, Van den Abbeele AD, Lin NU, Schwartzman A. Voxelwise single-subject analysis of imaging metabolic response to therapy in neuro-oncology. Stat (Int Stat Inst) 2014; 3:172-186. [PMID: 24999285 PMCID: PMC4078880 DOI: 10.1002/sta4.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
F-18-Fluorodeoxyglucose positron emission tomography (FDG-PET) has been used to evaluate the metabolic response of metastatic brain tumors to treatment by comparing their tumor glucose metabolism before and after treatment. The standard analysis based on regions-of-interest has the advantage of simplicity. However, it is by definition restricted to those regions and is subject to observer variability. In addition, the observed changes in tumor metabolism are often confounded by normal changes in the tissue background, which can be heterogenous. We propose an analysis pipeline for automatically detecting the change at each voxel in the entire brain of a single subject, while adjusting for changes in the background. The complete analysis includes image registration, segmentation, a hierarchical model for background adjustment and voxelwise statistical comparisons. We demonstrate the method's ability to identify areas of tumor response and/or progression in two subjects enrolled in a clinical trial using FDG-PET to evaluate lapatinib for the treatment of brain metastases in breast cancer patients.
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Affiliation(s)
- Mengye Guo
- Department of Biostatistics, University of Washington, 6200 NE 74th St, Seattle, WA, 98115
| | - Jeffrey T. Yap
- Center for Quantitative Cancer Imaging, University of Utah, 2000 Circle of Hope, Salt Lake City, UT 84112
| | - Annick D. Van den Abbeele
- Department of Imaging, Dana-Farber/Harvard Cancer Center, 450 Brookline Avenue, DL101, Boston, MA 02215
| | - Nancy U. Lin
- Department of Medical Oncology, Dana-Farber/Harvard Cancer Center, 450 Brookline Avenue, Boston, MA 02215
| | - Armin Schwartzman
- Department of Statistics, North Carolina State University, 2311 Stinson Drive, Raleigh, NC 27615
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O'Regan K, Breen M, Ramaiya N, Jagannathan J, DiPiro PJ, Hodi FS, Van den Abbeele AD. Metastatic mucosal melanoma: imaging patterns of metastasis and recurrence. Cancer Imaging 2013; 13:626-32. [PMID: 24434078 PMCID: PMC3893893 DOI: 10.1102/1470-7330.2013.0055] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Mucosal melanoma is a rare but aggressive subtype of melanoma with unique clinicopathologic features. We hypothesize that mucosal melanoma shows predilection for separate and unique metastatic pathways. MATERIALS AND METHODS This was a retrospective analysis of 19 patients (5 men and 14 women; median age 60 years, range 38-76 years) with metastatic mucosal melanoma presenting to a tertiary oncology center between 2005 and 2010. We performed a review of medical records and histologic and imaging studies to evaluate the natural history, metastatic patterns and the role of imaging in the management of patients with advanced mucosal melanoma. RESULTS At presentation, disease was confined to the primary site (58%, n = 11) or to the regional lymph nodes (32%, n = 6) in most patients. The most common site of metastasis was the lungs (89%, n = 16), followed by the liver (67%, n = 12) and peritoneum (44%, n = 8). Sinonasal melanoma preferentially spread to the liver (100%, n = 4), vaginal melanoma to the lungs (100%, n = 7) and anal melanoma to the inguinal lymph nodes (100%, n = 4). CONCLUSION Pathways of metastatic spread in mucosal melanoma may differ from other forms of melanoma and between different primary sites of mucosal origin.
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Affiliation(s)
- Kevin O'Regan
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Micheál Breen
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | | | | | | | - F Stephen Hodi
- Department of Cutaneous Oncology Program, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, USA
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Krajewski KM, Nishino M, Franchetti Y, Ramaiya NH, Van den Abbeele AD, Choueiri TK. Intraobserver and interobserver variability in computed tomography size and attenuation measurements in patients with renal cell carcinoma receiving antiangiogenic therapy: implications for alternative response criteria. Cancer 2013; 120:711-21. [PMID: 24264883 DOI: 10.1002/cncr.28493] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/23/2013] [Accepted: 10/28/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Alternative response criteria have been proposed in patients with metastatic renal cell carcinoma (mRCC) who are receiving vascular endothelial growth factor (VEGF)-targeted therapy, including 10% tumor shrinkage as an indicator of response/outcome. However, to the authors' knowledge, intraobserver and interobserver measurement variability have not been defined in this setting. The objective of the current study was to determine intraobserver and interobserver agreement of computed tomography (CT) size and attenuation measurements to establish reproducible response indicators. METHODS Seventy-one patients with mRCC with 179 target lesions were enrolled in phase 2 and phase 3 trials of VEGF-targeted therapies and retrospectively studied with Institutional Review Board approval. Two radiologists independently measured the long axis diameter and mean attenuation of target lesions at baseline and on follow-up CT. Concordance correlation coefficients and Bland-Altman plots were used to assess intraobserver and interobserver agreement. RESULTS High concordance correlation coefficients (range, 0.8602-0.9984) were observed in all types of measurements. The 95% limits of agreement for the percentage change of the sum longest diameter was -7.30% to 7.86% for intraobserver variability, indicating that 10% tumor shrinkage represents a true change in tumor size when measured by a single observer. The 95% limits of interobserver variability were -16.3% to 15.4%. On multivariate analysis, the location of the lesion was found to significantly contribute to interobserver variability (P = .048). The 95% limits of intraobserver agreement for the percentage change in CT attenuation were -18.34% to 16.7%. CONCLUSIONS In patients with mRCC who are treated with VEGF inhibitors, 10% tumor shrinkage is a reproducible radiologic response indicator when baseline and follow-up studies are measured by a single radiologist. Lesion location contributes significantly to measurement variability and should be considered when selecting target lesions.
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Affiliation(s)
- Katherine M Krajewski
- Department of Imaging, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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Yeh ED, Jacene HA, Bellon JR, Nakhlis F, Birdwell RL, Georgian-Smith D, Giess CS, Hirshfield-Bartek J, Overmoyer B, Van den Abbeele AD. What Radiologists Need to Know about Diagnosis and Treatment of Inflammatory Breast Cancer: A Multidisciplinary Approach. Radiographics 2013; 33:2003-17. [DOI: 10.1148/rg.337135503] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pyo J, Won Kim K, Jacene HA, Sakellis CG, Brown JR, Van den Abbeele AD. End-Therapy Positron Emission Tomography for Treatment Response Assessment in Follicular Lymphoma: A Systematic Review and Meta-analysis. Clin Cancer Res 2013; 19:6566-77. [DOI: 10.1158/1078-0432.ccr-13-1511] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hodi FS, Corless CL, Giobbie-Hurder A, Fletcher JA, Zhu M, Marino-Enriquez A, Friedlander P, Gonzalez R, Weber JS, Gajewski TF, O'Day SJ, Kim KB, Lawrence D, Flaherty KT, Luke JJ, Collichio FA, Ernstoff MS, Heinrich MC, Beadling C, Zukotynski KA, Yap JT, Van den Abbeele AD, Demetri GD, Fisher DE. Imatinib for melanomas harboring mutationally activated or amplified KIT arising on mucosal, acral, and chronically sun-damaged skin. J Clin Oncol 2013; 31:3182-90. [PMID: 23775962 DOI: 10.1200/jco.2012.47.7836] [Citation(s) in RCA: 381] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Amplifications and mutations in the KIT proto-oncogene in subsets of melanomas provide therapeutic opportunities. PATIENTS AND METHODS We conducted a multicenter phase II trial of imatinib in metastatic mucosal, acral, or chronically sun-damaged (CSD) melanoma with KIT amplifications and/or mutations. Patients received imatinib 400 mg once per day or 400 mg twice per day if there was no initial response. Dose reductions were permitted for treatment-related toxicities. Additional oncogene mutation screening was performed by mass spectroscopy. RESULTS Twenty-five patients were enrolled (24 evaluable). Eight patients (33%) had tumors with KIT mutations, 11 (46%) with KIT amplifications, and five (21%) with both. Median follow-up was 10.6 months (range, 3.7 to 27.1 months). Best overall response rate (BORR) was 29% (21% excluding nonconfirmed responses) with a two-stage 95% CI of 13% to 51%. BORR was significantly greater than the hypothesized null of 5% and statistically significantly different by mutation status (7 of 13 or 54% KIT mutated v 0% KIT amplified only). There were no statistical differences in rates of progression or survival by mutation status or by melanoma site. The overall disease control rate was 50% but varied significantly by KIT mutation status (77% mutated v 18% amplified). Four patients harbored pretreatment NRAS mutations, and one patient acquired increased KIT amplification after treatment. CONCLUSION Melanomas that arise on mucosal, acral, or CSD skin should be assessed for KIT mutations. Imatinib can be effective when tumors harbor KIT mutations, but not if KIT is amplified only. NRAS mutations and KIT copy number gain may be mechanisms of therapeutic resistance to imatinib.
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Affiliation(s)
- F Stephen Hodi
- F. Stephen Hodi, Anita Giobbie-Hurder, Philip Friedlander, Jason J. Luke, Katherine A. Zukotynski, Jeffrey T. Yap, Annick D. Van den Abbeele, and George D. Demetri, Dana-Farber Cancer Institute; Jonathan A. Fletcher, Meijun Zhu, and Adrian Marino-Enriquez, Brigham and Women's Hospital; Donald Lawrence, Keith T. Flaherty, and David E. Fisher, Massachusetts General Hospital, Boston, MA; Christopher L. Corless, Michael C. Heinrich, and Carol Beadling, Portland Veterans Administration Medical Center and Oregon Health & Science University, Portland, OR; Philip Friedlander, Mount Sinai Medical Center, New York, NY; Rene Gonzalez, University of Colorado Cancer Center, Aurora, CO; Jeffrey S. Weber, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Thomas F. Gajewski, University of Chicago, Chicago, IL; Steven J. O'Day, Beverly Hills Cancer Center, Beverly Hills, CA; Kevin B. Kim, The University of Texas MD Anderson Cancer Center, Houston, TX; Frances A. Collichio, The University of North Carolina at Chapel Hill, Chapel Hill, NC; and Marc S. Ernstoff, Geisel School of Medicine and Norris Cotton Cancer Center, Hanover, NH
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George S, Wang Q, Heinrich MC, Corless CL, Zhu M, Butrynski JE, Morgan JA, Wagner AJ, Choy E, Tap WD, Yap JT, Van den Abbeele AD, Manola JB, Solomon SM, Fletcher JA, von Mehren M, Demetri GD. Efficacy and safety of regorafenib in patients with metastatic and/or unresectable GI stromal tumor after failure of imatinib and sunitinib: a multicenter phase II trial. J Clin Oncol 2012; 30:2401-7. [PMID: 22614970 PMCID: PMC3675695 DOI: 10.1200/jco.2011.39.9394] [Citation(s) in RCA: 203] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 03/06/2012] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Metastatic GI stromal tumor (GIST) is a life-threatening disease with no therapy of proven efficacy after failure of imatinib and sunitinib. Regorafenib is a structurally unique inhibitor of multiple cancer-associated kinases, including KIT and platelet-derived growth factor receptor (PDGFR), with broad-spectrum anticancer activity in preclinical and early-phase trials. Because KIT and PDGFR-α remain drivers of GIST after resistance to imatinib and sunitinib, we performed a multicenter single-stage phase II trial of regorafenib in patients with advanced GIST after failure of at least imatinib and sunitinib. PATIENTS AND METHODS Patients received regorafenib orally, 160 mg daily, on days 1 to 21 of a 28-day cycle. Disease assessment was performed every two cycles per RECIST 1.1. Primary end point was clinical benefit rate (CBR), defined as objective responses (ie, complete or partial response [PR] as well as stable disease [SD] ≥ 16 weeks). Serial tumor biopsies were obtained from consenting patients whenever possible. RESULTS From February to December 2010, 34 patients were enrolled at four US centers. As of July 28, 2011, 33 patients had received at least two cycles of regorafenib (range, two to 17 cycles). CBR was 79% (95% CI, 61% to 91%). Four patients achieved PR, and 22 exhibited SD ≥ 16 weeks. Median progression-free survival was 10.0 months. The most common grade 3 toxicities were hypertension and hand-foot-skin reaction. CONCLUSION Regorafenib has significant activity in patients with advanced GIST after failure of both imatinib and sunitinib. A phase III trial of regorafenib versus placebo is ongoing to define more fully the safety and efficacy of regorafenib in this setting.
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Affiliation(s)
- Suzanne George
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute D1212, 450 Brookline Ave, Boston, MA, USA.
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Halasz LM, Jacene HA, Catalano PJ, Van den Abbeele AD, Lacasce A, Mauch PM, Ng AK. Combined modality treatment for PET-positive non-Hodgkin lymphoma: favorable outcomes of combined modality treatment for patients with non-Hodgkin lymphoma and positive interim or postchemotherapy FDG-PET. Int J Radiat Oncol Biol Phys 2012; 83:e647-54. [PMID: 22607911 DOI: 10.1016/j.ijrobp.2012.01.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 12/17/2011] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate outcomes of patients treated for aggressive non-Hodgkin lymphoma (NHL) with combined modality therapy based on [(18)F]fluoro-2-deoxy-2-d-glucose positron emission tomography (FDG-PET) response. METHODS AND MATERIALS We studied 59 patients with aggressive NHL, who received chemotherapy and radiation therapy (RT) from 2001 to 2008. Among them, 83% of patients had stage I/II disease. Patients with B-cell lymphoma received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone)-based chemotherapy, and 1 patient with anaplastic lymphoma kinase-negative anaplastic T-cell lymphoma received CHOP therapy. Interim and postchemotherapy FDG-PET or FDG-PET/computed tomography (CT) scans were performed for restaging. All patients received consolidated involved-field RT. Median RT dose was 36 Gy (range, 28.8-50 Gy). Progression-free survival (PFS) and local control (LC) rates were calculated with and without a negative interim or postchemotherapy FDG-PET scan. RESULTS Median follow-up was 46.5 months. Thirty-nine patients had negative FDG-PET results by the end of chemotherapy, including 12 patients who had a negative interim FDG-PET scan and no postchemotherapy PET. Twenty patients were FDG-PET-positive, including 7 patients with positive interim FDG-PET and no postchemotherapy FDG-PET scans. The 3-year actuarial PFS rates for patients with negative versus positive FDG-PET scans were 97% and 90%, respectively. The 3-year actuarial LC rates for patients with negative versus positive FDG-PET scans were 100% and 90%, respectively. CONCLUSIONS Patients who had a positive interim or postchemotherapy FDG-PET had a PFS rate of 90% at 3 years after combined modality treatment, suggesting that a large proportion of these patients can be cured with consolidated RT.
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Affiliation(s)
- Lia M Halasz
- Harvard Radiation Oncology Program, Boston, Massachusetts, USA
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Van den Abbeele AD, Gatsonis C, de Vries DJ, Melenevsky Y, Szot-Barnes A, Yap JT, Godwin AK, Rink L, Huang M, Blevins M, Sicks J, Eisenberg B, Siegel BA. ACRIN 6665/RTOG 0132 phase II trial of neoadjuvant imatinib mesylate for operable malignant gastrointestinal stromal tumor: monitoring with 18F-FDG PET and correlation with genotype and GLUT4 expression. J Nucl Med 2012; 53:567-74. [PMID: 22381410 DOI: 10.2967/jnumed.111.094425] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED We investigated the correlation between metabolic response by (18)F-FDG PET and objective response, glucose transporter type 4 (GLUT4) expression, and KIT/PDGFRA mutation status in patients with gastrointestinal stromal tumor undergoing neoadjuvant imatinib mesylate therapy. METHODS (18)F-FDG PET was performed at baseline, 1-7 d, and 4 or 8 wk after imatinib mesylate initiation. Best objective response was defined by version 1.0 of the Response Evaluation Criteria in Solid Tumors (RECIST). Mutational analysis and tumor GLUT4 expression by immunohistochemistry were done on tissue obtained at baseline or surgery. RESULTS (18)F-FDG PET showed high baseline tumor glycolytic activity (mean SUV(max), 14.2; range, 1.3-53.2), decreasing after 1 wk of imatinib mesylate (mean, 5.5; range, -0.5-47.7, P < 0.001, n = 44), and again before surgery (mean, 3.0; range, -0.5-36.1, P < 0.001, n = 40). At week 1, there were 3 patients with complete metabolic response (CMR), 33 with partial metabolic response (PMR), 6 with stable metabolic disease (SMD), and 2 with progressive metabolic disease (PMD). Before surgery, there were 3 with CMR, 33 with PMR, 4 with SMD, and none with PMD. The best response according to RECIST was 2 with partial response, 36 with stable disease, and 1 with progressive disease (n = 39). Of the patients with a posttreatment decrease in GLUT4 expression, 1 had CMR, 15 had PMR, 2 had SMD, and 1 had PMD at week 1, whereas before surgery 1 patient had CMR, 16 had PMR, 2 had SMD, and none had PMD. Among 27 patients with KIT exon 11 mutations, 1 had CMR, 22 had PMR, 3 had SMD, and 1 had PMD at week 1, whereas 1 had CMR, 22 had PMR, 2 had SMD, and 2 were unknown before surgery; among 4 patients with a wild-type genotype, 2 had PMR and 2 SMD at week 1, whereas 1 had CMR, 2 had PMR, and 1 had SMD before surgery. CONCLUSION After imatinib mesylate initiation, metabolic response by (18)F-FDG PET was documented earlier (1-7 d) and was of much greater magnitude (36/44) than that documented by RECIST (2/39). Immunohistochemistry data suggest that GLUT4 may play a role in (18)F-FDG uptake in gastrointestinal stromal tumor, GLUT4 levels decrease after imatinib mesylate therapy in most patients with PMR, and the biologic action of imatinib mesylate interacts with glycolysis and GLUT4 expression. A greater than 85% metabolic response was observed as early as days 1-7 in patients with exon 11 mutations.
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Abstract
Imaging plays a central role in the detection, diagnosis, staging, and follow-up of renal cell carcinoma (RCC). Most renal masses are incidentally detected with modern, high-resolution imaging techniques and a variety of management options exist for the renal masses encountered today. This article discusses the role of multiple imaging modalities in the diagnosis of RCC and the imaging features of specific pathologic subtypes and staging techniques. Future directions in RCC imaging are presented, including dynamic contrast-enhanced and unenhanced techniques, as well as the development of novel tracers for positron emission tomography.
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Affiliation(s)
- Katherine M Krajewski
- Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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Nishino M, Jackman DM, Hatabu H, Jänne PA, Johnson BE, Van den Abbeele AD. Imaging of lung cancer in the era of molecular medicine. Acad Radiol 2011; 18:424-36. [PMID: 21277232 DOI: 10.1016/j.acra.2010.10.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 10/28/2010] [Accepted: 10/30/2010] [Indexed: 12/17/2022]
Abstract
Recent discoveries characterizing the molecular basis of lung cancer brought fundamental changes in lung cancer treatment. The authors review the molecular pathogenesis of lung cancer, including genomic abnormalities, targeted therapies, and resistance mechanisms, and discuss lung cancer imaging with novel techniques. Knowledge of the molecular basis of lung cancer is essential for radiologists to properly interpret imaging and assess response to therapy. Quantitative and functional imaging helps assessing the biologic behavior of lung cancer.
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Shinagare AB, Guo M, Hatabu H, Krajewski KM, Andriole K, Van den Abbeele AD, DiPiro PJ, Nishino M. Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center. Cancer 2011; 117:3860-6. [PMID: 21319153 DOI: 10.1002/cncr.25941] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 12/08/2010] [Accepted: 12/16/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Incidence of pulmonary embolism (PE) for different cancer types in oncology outpatients is unknown. The purposes of the current study is to determine the incidence of PE in oncology outpatients and to investigate whether the incidence for PE is higher in certain cancers. METHODS A cohort of oncology outpatients who had imaging studies at Dana-Farber Cancer Institute, a tertiary outpatient cancer institute, from January 2004 through December 2009 was identified using research patient data registry. Radiology reports were reviewed to identify patients who developed PE. Incidences of PE in the total population and in each of 16 predefined cancer groups were calculated. Risk of PE for each cancer was compared using Fisher exact test. RESULTS A total of 13,783 patients was identified, of which 395 (2.87%; 95% confidence interval [CI], 2.59-3.16) developed PE. The incidence of PE was highest in the central nervous system ([CNS] 12.90%; 95% CI, 8.45-18.59), hepatobiliary (6.85%; 95% CI, 3.33-12.24), pancreatic (5.81%; 95% CI, 3.59-8.84), and upper gastrointestinal (5.81%; 95% CI, 3.96-8.20) malignancies. The risk of PE was significantly higher for CNS (P < .0001; odds ratio [OR], 5.28), pancreatic (P = .0027; OR, 2.15), upper gastrointestinal (P = .0002; OR, 2.18), and lung/pleural malignancies (P = .0028; OR, 1.45). There was significantly lower risk of PE for hematologic (incidence, 1.16%; 95% CI, 0.79-1.64; P < .0001; OR, 0.35) and breast malignancies (incidence, 1.50%; 95% CI, 1.02-2.11; P < .0001; OR, 0.47). CONCLUSIONS The incidence of PE in oncology outpatients in a tertiary cancer center during a 6-year period was 2.87%. CNS, pancreatic, upper gastrointestinal, and lung/pleural malignancies had a significantly higher risk for PE than other malignancies, whereas hematologic and breast malignancies had a significantly lower risk.
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Affiliation(s)
- Atul B Shinagare
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA
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Krajewski KM, Guo M, Van den Abbeele AD, Yap J, Ramaiya N, Jagannathan J, Heng DYC, Atkins MB, McDermott DF, Schutz FAB, Pedrosa I, Choueiri TK. Comparison of four early posttherapy imaging changes (EPTIC; RECIST 1.0, tumor shrinkage, computed tomography tumor density, Choi criteria) in assessing outcome to vascular endothelial growth factor-targeted therapy in patients with advanced renal cell carcinoma. Eur Urol 2011; 59:856-62. [PMID: 21306819 DOI: 10.1016/j.eururo.2011.01.038] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 01/21/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF)-targeted therapy has become standard treatment for patients with metastatic renal cell cancer (mRCC). Since these therapies can induce tumor necrosis and minimal tumor shrinkage, Response Evaluation Criteria in Solid Tumors (RECIST) may not be optimal for predicting clinical outcome. OBJECTIVE To systematically determine the optimal early posttherapy imaging changes (EPTIC) to separate responders and nonresponders at the first posttreatment follow-up computed tomography (CT). DESIGN, SETTING, AND PARTICIPANTS Seventy mRCC patients with 155 target lesions treated with first-line sunitinib, sorafenib, or bevacizumab at academic medical centers underwent contrast-enhanced thoracic and abdominal CT at baseline and first follow-up after therapy initiation (median: 78 d after therapy initiation; range: 31-223 d). MEASUREMENTS Evaluations were performed according to (1) RECIST 1.0; (2) Choi criteria; (3) tumor shrinkage (TS) of ≥10% decrease in sum of the longest unidimensional diameter (SLD); and (4) 15% or 20% decrease in mean CT tumor density. Correlation with time to treatment failure (TTF) and overall survival (OS) were compared and stratified by response to each of the radiologic criteria. RESULTS AND LIMITATIONS Eleven patients were considered responders by RECIST 1.0; 49 based on Choi criteria; 31 patients had ≥10% decrease in the SLD; and 36 and 32 patients had ≥15% and ≥20% decrease, respectively, in mean tumor density on CT. Only the threshold of 10% decrease in the SLD was statistically significant in predicting TTF (10.4 vs 5.1 mo; p=0.02) and OS (32.5 vs 15.8 mo; p=0.002). Receiver operating characteristic analysis yielded a 10% decrease in SLD as the optimal size change threshold for responders. The retrospective nature of the study and measurements by a single oncoradiologist are inherent limitations. CONCLUSIONS In the retrospectively analyzed study population of mRCC patients receiving VEGF-targeted agents, a 10% reduction in the SLD on the first follow-up CT was an optimal early predictor of outcome.
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Nishino M, Guo M, Jackman DM, DiPiro PJ, Yap JT, Ho TK, Hatabu H, Jänne PA, Van den Abbeele AD, Johnson BE. CT tumor volume measurement in advanced non-small-cell lung cancer: Performance characteristics of an emerging clinical tool. Acad Radiol 2011; 18:54-62. [PMID: 21036632 DOI: 10.1016/j.acra.2010.08.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 08/28/2010] [Accepted: 08/31/2010] [Indexed: 10/18/2022]
Abstract
RATIONALE AND OBJECTIVES Determine inter- and intraobserver variability of computed tomography (CT) tumor volume measurements in advanced non-small-cell lung cancer (NSCLC) patients treated in a Phase II clinical trial using chest CT. MATERIALS AND METHODS Twenty-three advanced NSCLC patients with a total of 53 measurable lung lesions enrolled in a Phase II, multicenter, open-label clinical trial of erlotinib were retrospectively studied with institutional review board approval. Two radiologists independently measured the tumor size, volume, and CT attenuation coefficient using commercially available volume analysis software. Concordance correlation coefficients (CCCs) and Bland-Altman plots were used to assess inter- and intraobserver agreement. RESULTS High CCCs (0.949-0.990) were observed in all types of measurements for interobserver agreement. The 95% limits of agreements for volume, unidimensional, and bidimensional measurements were (-26.0%, 18.6%), (-23.1%, 24.4%), and (-34.0%, 48.6%), respectively. Volume measurement had slightly higher CCC and narrower 95% limits of agreement compared to uni- and bidimensional measurements. CCCs for intraobserver agreement were high (range, 0.946-0.996) with CCC for volume being slightly higher than CCCs of uni- and bidimensional measurements. The smaller the tumor volume was, the larger the interobserver difference of CT attenuation. Location, morphology, or adjacent atelectasis had no significant impact on inter- or intraobserver variability. CONCLUSION CT tumor volume measurement in advanced NSCLC patients using clinical chest CT and commercially available software demonstrated high inter- and intraobserver agreement, indicating that the method may be used routinely in clinical practice.
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Lee AI, Zuckerman DS, Van den Abbeele AD, Aquino SL, Crowley D, Toomey C, Lacasce AS, Feng Y, Neuberg DS, Hochberg EP. Surveillance imaging of Hodgkin lymphoma patients in first remission. Cancer 2010; 116:3835-42. [PMID: 20564135 DOI: 10.1002/cncr.25240] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alfred Ian Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02114, USA
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Demetri GD, Heinrich MC, Fletcher JA, Fletcher CDM, Van den Abbeele AD, Corless CL, Antonescu CR, George S, Morgan JA, Chen MH, Bello CL, Huang X, Cohen DP, Baum CM, Maki RG. Molecular target modulation, imaging, and clinical evaluation of gastrointestinal stromal tumor patients treated with sunitinib malate after imatinib failure. Clin Cancer Res 2009; 15:5902-9. [PMID: 19737946 DOI: 10.1158/1078-0432.ccr-09-0482] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate sunitinib activity and potential cellular and molecular correlates in gastrointestinal stromal tumor (GIST) patients after imatinib failure, in addition to assessing the safety and pharmacokinetics (PK) of different dose schedules. EXPERIMENTAL DESIGN In this open-label, dose-ranging, phase I/II study, 97 patients with metastatic imatinib-resistant/intolerant GIST received sunitinib at doses of 25, 50, or 75 mg/d on one of three schedules. Serial tumor imaging was done using computed tomography and [18F]fluoro-2-deoxy-d-glucose positron emission tomography scanning. PK and cell proliferation and KIT phosphorylation status in tumor biopsies were also analyzed. RESULTS Clinical benefit was observed in 52 patients (54%: 7 objective partial responses, 45 stable disease > or =6 months). Decreased tumor glycolytic activity was shown in most patients within 7 days of starting sunitinib using [18F]fluoro-2-deoxy-d-glucose positron emission tomography. Sunitinib treatment was associated with reduced tumor cell proliferation by >25% in 52% of cases analyzed and reduced levels of phospho-KIT in tumor biopsies (indicating target modulation). The recommended dose schedule was 50 mg/d for 4 weeks followed by 2 weeks off treatment. On the 50-mg dose across all schedules, 79% of PK-evaluable patients achieved total drug trough concentrations above the target concentration (50 ng/mL) within 14 days of dosing. In addition, adverse events were generally mild to moderate in severity. CONCLUSION Cellular and molecular analyses showed that sunitinib clinical activity is associated with inhibition of KIT in GIST following imatinib failure, illustrating the rational approach used to develop a therapy aimed at the underlying oncogenic signaling pathway aberrancy.
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Affiliation(s)
- George D Demetri
- Center for Sarcoma and Bone Oncology, Ludwig Center at Dana-Farber/Harvard Cancer Center, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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George S, Merriam P, Maki RG, Van den Abbeele AD, Yap JT, Akhurst T, Harmon DC, Bhuchar G, O'Mara MM, D'Adamo DR, Morgan J, Schwartz GK, Wagner AJ, Butrynski JE, Demetri GD, Keohan ML. Multicenter phase II trial of sunitinib in the treatment of nongastrointestinal stromal tumor sarcomas. J Clin Oncol 2009; 27:3154-60. [PMID: 19451429 DOI: 10.1200/jco.2008.20.9890] [Citation(s) in RCA: 235] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To evaluate the potential benefit of continuous daily dosing sunitinib in patients with advanced nongastrointestinal stromal tumor (GIST) sarcomas. PATIENTS AND METHODS A total of 53 patients with advanced non-GIST soft tissue sarcomas received sunitinib 37.5 mg daily. Primary end point was Response Evaluation Criteria in Solid Tumors defined response. Secondary end points were stable disease at 16 and 24 weeks. [(18)F]-fluorodeoxyglucose positron emission tomography was performed on a subset of 24 patients at baseline and after 10 to 14 days of therapy. Results Forty-eight patients were eligible for response. One patient (desmoplastic round cell tumor [DSRCT]) achieved a confirmed partial response (PR) and remained on study for 56 weeks. Ten patients (20%) achieved stable disease for at least 16 weeks. Metabolic PR was seen in 10 (47%) of 21 of patients. Metabolic stable disease was seen in 11 (52%) of 21. There were no unexpected toxicities observed. CONCLUSION Sunitinib demonstrated notable evidence of metabolic response in several patients with non-GIST sarcoma. The relevance of disease control observed in subtypes with an indolent natural history is unknown, however, the durable disease control observed in DSRCT, solitary fibrous tumor, and giant cell tumor of bone suggests that future evaluation of sunitinib in these subtypes may be warranted.
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Affiliation(s)
- Suzanne George
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, 44 Binney St, D1210, Boston, MA 02115, USA.
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Van den Abbeele AD, Ertuk M. FDG-PET to Measure Response to Targeted Therapy: The Example of Gastrointestinal Stromal Tumor and Imatinib Mesylate (Gleevec). PET Clin 2008; 3:77-87. [PMID: 27158147 DOI: 10.1016/j.cpet.2008.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Imaging has played a major role in the evaluation of molecular targeted therapies in patients with gastrointestinal stromal tumors. FDG-PET has been instrumental in the evaluation of the tyrosine kinase inhibitors used to treat this disease. Imaging findings on FDG-PET and CT have illustrated the need to re-evaluate traditional response assessment criteria. Because most PET studies are now performed on hybrid PET/CT scanners, there is an opportunity to test and validate existing and new PET tracers and to provide anatomic and functional information in one setting. The inclusion of imaging in the testing and implementation of targeted therapies is helping to define the concept of personalized medicine.
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Affiliation(s)
- Annick D Van den Abbeele
- Harvard Medical School, Boston, MA, USA; Department of Radiology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA; Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Tumor Imaging Metrics Core, Dana-Farber/Harvard Cancer Center, Boston, MA, USA.
| | - Mehmet Ertuk
- Department of Radiology, Sisli Etfal Training and Research Hospital, Şişli 34360, Istanbul, Turkey
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Erturk SM, Van den Abbeele AD. Role of PET/CT scanning in initial and post-treatment assessment of Hodgkin disease. J Natl Compr Canc Netw 2008; 6:623-32. [PMID: 18597714 DOI: 10.6004/jnccn.2008.0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 04/29/2008] [Indexed: 11/17/2022]
Abstract
The add-on value of F18-fluorodeoxyglucose PET, particularly when combined with CT, to the conventional workup in managing patients with Hodgkin disease has now been well documented. This article reviews the use of these imaging modalities in the initial staging and post-treatment assessment of Hodgkin disease.
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Affiliation(s)
- Sukru Mehmet Erturk
- Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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