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Rata M, De Paepe KN, Orton MR, Castagnoli F, d'Arcy J, Winfield JM, Hughes J, Stemmer A, Nickel MD, Koh DM. Evaluation of simultaneous multi-slice acquisition with advanced processing for free-breathing diffusion-weighted imaging in patients with liver metastasis. Eur Radiol 2024; 34:2457-2467. [PMID: 37776361 PMCID: PMC10957610 DOI: 10.1007/s00330-023-10234-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/28/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES Diffusion-weighted imaging (DWI) with simultaneous multi-slice (SMS) acquisition and advanced processing can accelerate acquisition time and improve MR image quality. This study evaluated the image quality and apparent diffusion coefficient (ADC) measurements of free-breathing DWI acquired from patients with liver metastases using a prototype SMS-DWI acquisition (with/without an advanced processing option) and conventional DWI. METHODS Four DWI schemes were compared in a pilot 5-patient cohort; three DWI schemes were further assessed in a 24-patient cohort. Two readers scored image quality of all b-value images and ADC maps across the three methods. ADC measurements were performed, for all three methods, in left and right liver parenchyma, spleen, and liver metastases. The Friedman non-parametric test (post-hoc Wilcoxon test with Bonferroni correction) was used to compare image quality scoring; t-test was used for ADC comparisons. RESULTS SMS-DWI was faster (by 24%) than conventional DWI. Both readers scored the SMS-DWI with advanced processing as having the best image quality for highest b-value images (b750) and ADC maps; Cohen's kappa inter-reader agreement was 0.6 for b750 image and 0.56 for ADC maps. The prototype SMS-DWI sequence with advanced processing allowed a better visualization of the left lobe of the liver. ADC measured in liver parenchyma, spleen, and liver metastases using the SMS-DWI with advanced processing option showed lower values than those derived from the SMS-DWI method alone (t-test, p < 0.0001; p < 0.0001; p = 0.002). CONCLUSIONS Free-breathing SMS-DWI with advanced processing was faster and demonstrated better image quality versus a conventional DWI protocol in liver patients. CLINICAL RELEVANCE STATEMENT Free-breathing simultaneous multi-slice- diffusion-weighted imaging (DWI) with advanced processing was faster and demonstrated better image quality versus a conventional DWI protocol in liver patients. KEY POINTS • Diffusion-weighted imaging (DWI) with simultaneous multi-slice (SMS) can accelerate acquisition time and improve image quality. • Apparent diffusion coefficients (ADC) measured in liver parenchyma, spleen, and liver metastases using the simultaneous multi-slice DWI with advanced processing were significantly lower than those derived from the simultaneous multi-slice DWI method alone. • Simultaneous multi-slice DWI sequence with inline advanced processing was faster and demonstrated better image quality in liver patients.
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Affiliation(s)
- Mihaela Rata
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
| | - Katja N De Paepe
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew R Orton
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Francesca Castagnoli
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - James d'Arcy
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Jessica M Winfield
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Julie Hughes
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Alto Stemmer
- Siemens Healthcare GmbH, MR Application Predevelopment, Erlangen, Germany
| | | | - Dow-Mu Koh
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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Donners R, Candito A, Blackledge M, Rata M, Messiou C, Koh DM, Tunariu N. Repeatability of quantitative individual lesion and total disease multiparametric whole-body MRI measurements in prostate cancer bone metastases. Br J Radiol 2023; 96:20230378. [PMID: 37660399 PMCID: PMC10607420 DOI: 10.1259/bjr.20230378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVES To assess the repeatability of quantitative multiparametric whole-body MRI (mpWB-MRI) parameters in advanced prostate cancer (APC) bone metastases. METHODS 1.5T MRI was performed twice on the same day in 10 APC patients. MpWB-MRI-included diffusion weighted imaging (DWI) and T1-weighted gradient-echo 2-point Dixon sequences. ADC and relative fat-fraction percentage (rFF%) maps were calculated, respectively. A radiologist delineated up to 10 target bone metastases per study. Means of ADC, b900 signal intensity(SI), normalised b900 SI, rFF% and maximum diameter (MD) for each target lesion and overall parameter averages across all targets per patient were recorded. The total disease volume (tDV in ml) was manually delineated on b900 images and mean global (g)ADC was derived. Bland-Altman analyses were performed with calculation of 95% repeatability coefficients (RC). RESULTS Seventy-three individual targets (median MD 26 mm) were included. Lesion mean ADC RC was 12.5%, mean b900 SI RC 137%, normalised mean b900 SI RC 110%, rFF% RC 3.2 and target MD RC 5.5 mm (16.3%). Patient target lesion average mean ADC RC was 6.4%, b900 SI RC 104% and normalised mean b900 SI RC 39.6%. Target average rFF% RC was 1.8, average MD RC 1.3 mm (4.8%). tDV segmentation RC was 6.4% and mean gADC RC 5.3%. CONCLUSIONS APC bone metastases' ADC, rFF% and maximum diameter, tDV and gADC show good repeatability. ADVANCES IN KNOWLEDGE APC bone metastases' mean ADC and rFF% measurements of single lesions and global disease volumes are repeatable, supporting their potential role as quantitative biomarkers in metastatic bone disease.
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Affiliation(s)
| | - Antonio Candito
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, Sutton, United Kingdom
| | - Matthew Blackledge
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, Sutton, United Kingdom
| | - Mihaela Rata
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, Sutton, United Kingdom
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Keaveney S, Dragan A, Rata M, Blackledge M, Scurr E, Winfield JM, Shur J, Koh DM, Porta N, Candito A, King A, Rennie W, Gaba S, Suresh P, Malcolm P, Davis A, Nilak A, Shah A, Gandhi S, Albrizio M, Drury A, Pratt G, Cook G, Roberts S, Jenner M, Brown S, Kaiser M, Messiou C. Image quality in whole-body MRI using the MY-RADS protocol in a prospective multi-centre multiple myeloma study. Insights Imaging 2023; 14:170. [PMID: 37840055 PMCID: PMC10577121 DOI: 10.1186/s13244-023-01498-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/08/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND The Myeloma Response Assessment and Diagnosis System (MY-RADS) guidelines establish a standardised acquisition and analysis pipeline for whole-body MRI (WB-MRI) in patients with myeloma. This is the first study to assess image quality in a multi-centre prospective trial using MY-RADS. METHODS The cohort consisted of 121 examinations acquired across ten sites with a range of prior WB-MRI experience, three scanner manufacturers and two field strengths. Image quality was evaluated qualitatively by a radiologist and quantitatively using a semi-automated pipeline to quantify common artefacts and image quality issues. The intra- and inter-rater repeatability of qualitative and quantitative scoring was also assessed. RESULTS Qualitative radiological scoring found that the image quality was generally good, with 94% of examinations rated as good or excellent and only one examination rated as non-diagnostic. There was a significant correlation between radiological and quantitative scoring for most measures, and intra- and inter-rater repeatability were generally good. When the quality of an overall examination was low, this was often due to low quality diffusion-weighted imaging (DWI), where signal to noise ratio (SNR), anterior thoracic signal loss and brain geometric distortion were found as significant predictors of examination quality. CONCLUSIONS It is possible to successfully deliver a multi-centre WB-MRI study using the MY-RADS protocol involving scanners with a range of manufacturers, models and field strengths. Quantitative measures of image quality were developed and shown to be significantly correlated with radiological assessment. The SNR of DW images was identified as a significant factor affecting overall examination quality. TRIAL REGISTRATION ClinicalTrials.gov, NCT03188172 , Registered on 15 June 2017. CRITICAL RELEVANCE STATEMENT Good overall image quality, assessed both qualitatively and quantitatively, can be achieved in a multi-centre whole-body MRI study using the MY-RADS guidelines. KEY POINTS • A prospective multi-centre WB-MRI study using MY-RADS can be successfully delivered. • Quantitative image quality metrics were developed and correlated with radiological assessment. • SNR in DWI was identified as a significant predictor of quality, allowing for rapid quality adjustment.
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Affiliation(s)
- Sam Keaveney
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
| | - Alina Dragan
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Mihaela Rata
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Matthew Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Erica Scurr
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jessica M Winfield
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Joshua Shur
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Dow-Mu Koh
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Antonio Candito
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Alexander King
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Winston Rennie
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Suchi Gaba
- University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Priya Suresh
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Paul Malcolm
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Amy Davis
- Epsom & St. Helier University Hospitals NHS Trust, Epsom, UK
| | | | - Aarti Shah
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | | | - Mauro Albrizio
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arnold Drury
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gordon Cook
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sadie Roberts
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Matthew Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Martin Kaiser
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Christina Messiou
- MRI Unit, The Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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Halford S, Veal GJ, Wedge SR, Payne GS, Bacon CM, Sloan P, Dragoni I, Heinzmann K, Potter S, Salisbury BM, Chenard-Poirier M, Greystoke A, Howell EC, Innes WA, Morris K, Plummer C, Rata M, Petrides G, Keun HC, Banerji U, Plummer R. A Phase I Dose-escalation Study of AZD3965, an Oral Monocarboxylate Transporter 1 Inhibitor, in Patients with Advanced Cancer. Clin Cancer Res 2023; 29:1429-1439. [PMID: 36652553 PMCID: PMC7614436 DOI: 10.1158/1078-0432.ccr-22-2263] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [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: 07/20/2022] [Revised: 10/20/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE Inhibition of monocarboxylate transporter (MCT) 1-mediated lactate transport may have cytostatic and/or cytotoxic effects on tumor cells. We report results from the dose-escalation part of a first-in-human trial of AZD3965, a first-in-class MCT1 inhibitor, in advanced cancer. PATIENTS AND METHODS This multicentre, phase I, dose-escalation and dose-expansion trial enrolled patients with advanced solid tumors or lymphoma and no standard therapy options. Exclusion criteria included history of retinal and/or cardiac disease, due to MCT1 expression in the eye and heart. Patients received daily oral AZD3965 according to a 3+3 then rolling six design. Primary objectives were to assess safety and determine the MTD and/or recommended phase II dose (RP2D). Secondary objectives for dose escalation included measurement of pharmacokinetic and pharmacodynamic activity. Exploratory biomarkers included tumor expression of MCT1 and MCT4, functional imaging of biological impact, and metabolomics. RESULTS During dose escalation, 40 patients received AZD3965 at 5-30 mg once daily or 10 or 15 mg twice daily. Treatment-emergent adverse events were primarily grade 1 and/or 2, most commonly electroretinogram changes (retinopathy), fatigue, anorexia, and constipation. Seven patients receiving ≥20 mg daily experienced dose-limiting toxicities (DLT): grade 3 cardiac troponin rise (n = 1), asymptomatic ocular DLTs (n = 5), and grade 3 acidosis (n = 1). Plasma pharmacokinetics demonstrated attainment of target concentrations; pharmacodynamic measurements indicated on-target activity. CONCLUSIONS AZD3965 is tolerated at doses that produce target engagement. DLTs were on-target and primarily dose-dependent, asymptomatic, reversible ocular changes. An RP2D of 10 mg twice daily was established for use in dose expansion in cancers that generally express high MCT1/low MCT4).
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Affiliation(s)
- Sarah Halford
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Gareth J Veal
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Stephen R Wedge
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Geoffrey S Payne
- Cancer Research UK Imaging Centre, The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Chris M Bacon
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Philip Sloan
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ilaria Dragoni
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Kathrin Heinzmann
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Sarah Potter
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Becky M Salisbury
- Cancer Research UK Centre for Drug Development, London, United Kingdom
| | - Maxime Chenard-Poirier
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Alastair Greystoke
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Elizabeth C Howell
- Newcastle University Centre for In Vivo Imaging, Newcastle, United Kingdom
| | - William A Innes
- Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Type, United Kingdom
| | - Karen Morris
- Cancer Research UK Manchester Institute Cancer Biomarker Centre, Manchester, United Kingdom
| | - Chris Plummer
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Mihaela Rata
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Ruth Plummer
- Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
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5
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Rata M, Blackledge M, Scurr E, Winfield J, Koh DM, Dragan A, Candito A, King A, Rennie W, Gaba S, Suresh P, Malcolm P, Davis A, Nilak A, Shah A, Gandhi S, Albrizio M, Drury A, Roberts S, Jenner M, Brown S, Kaiser M, Messiou C. Implementation of Whole-Body MRI (MY-RADS) within the OPTIMUM/MUKnine multi-centre clinical trial for patients with myeloma. Insights Imaging 2022; 13:123. [PMID: 35900614 PMCID: PMC9334517 DOI: 10.1186/s13244-022-01253-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole-body (WB) MRI, which includes diffusion-weighted imaging (DWI) and T1-w Dixon, permits sensitive detection of marrow disease in addition to qualitative and quantitative measurements of disease and response to treatment of bone marrow. We report on the first study to embed standardised WB-MRI within a prospective, multi-centre myeloma clinical trial (IMAGIMM trial, sub-study of OPTIMUM/MUKnine) to explore the use of WB-MRI to detect minimal residual disease after treatment. METHODS The standardised MY-RADS WB-MRI protocol was set up on a local 1.5 T scanner. An imaging manual describing the MR protocol, quality assurance/control procedures and data transfer was produced and provided to sites. For non-identical scanners (different vendor or magnet strength), site visits from our physics team were organised to support protocol optimisation. The site qualification process included review of phantom and volunteer data acquired at each site and a teleconference to brief the multidisciplinary team. Image quality of initial patients at each site was assessed. RESULTS WB-MRI was successfully set up at 12 UK sites involving 3 vendor systems and two field strengths. Four main protocols (1.5 T Siemens, 3 T Siemens, 1.5 T Philips and 3 T GE scanners) were generated. Scanner limitations (hardware and software) and scanning time constraint required protocol modifications for 4 sites. Nevertheless, shared methodology and imaging protocols enabled other centres to obtain images suitable for qualitative and quantitative analysis. CONCLUSIONS Standardised WB-MRI protocols can be implemented and supported in prospective multi-centre clinical trials. Trial registration NCT03188172 clinicaltrials.gov; registration date 15th June 2017 https://clinicaltrials.gov/ct2/show/study/NCT03188172.
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Affiliation(s)
- Mihaela Rata
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK.
| | - Matthew Blackledge
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Erica Scurr
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Jessica Winfield
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Dow-Mu Koh
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Alina Dragan
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Antonio Candito
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Alexander King
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Suchi Gaba
- Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Priya Suresh
- University Hospitals Plymouth NHS Foundation Trust, Plymouth, UK
| | - Paul Malcolm
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Amy Davis
- Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | | | - Aarti Shah
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - Mauro Albrizio
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arnold Drury
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Sadie Roberts
- University of Leeds Clinical Trial Research Unit, Leeds, UK
| | - Matthew Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Brown
- University of Leeds Clinical Trial Research Unit, Leeds, UK
| | - Martin Kaiser
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Christina Messiou
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
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Rata M, Khan K, Collins DJ, Koh DM, Tunariu N, Bali MA, d'Arcy J, Winfield JM, Picchia S, Valeri N, Chau I, Cunningham D, Fassan M, Leach MO, Orton MR. DCE-MRI is more sensitive than IVIM-DWI for assessing anti-angiogenic treatment-induced changes in colorectal liver metastases. Cancer Imaging 2021; 21:67. [PMID: 34924031 PMCID: PMC8684660 DOI: 10.1186/s40644-021-00436-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diffusion weighted imaging (DWI) with intravoxel incoherent motion (IVIM) modelling can inform on tissue perfusion without exogenous contrast administration. Dynamic-contrast-enhanced (DCE) MRI can also characterise tissue perfusion, but requires a bolus injection of a Gadolinium-based contrast agent. This study compares the use of DCE-MRI and IVIM-DWI methods in assessing response to anti-angiogenic treatment in patients with colorectal liver metastases in a cohort with confirmed treatment response. METHODS This prospective imaging study enrolled 25 participants with colorectal liver metastases to receive Regorafenib treatment. A target metastasis > 2 cm in each patient was imaged before and at 15 days after treatment on a 1.5T MR scanner using slice-matched IVIM-DWI and DCE-MRI protocols. MRI data were motion-corrected and tumour volumes of interest drawn on b=900 s/mm2 diffusion-weighted images were transferred to DCE-MRI data for further analysis. The median value of four IVIM-DWI parameters [diffusion coefficient D (10-3 mm2/s), perfusion fraction f (ml/ml), pseudodiffusion coefficient D* (10-3 mm2/s), and their product fD* (mm2/s)] and three DCE-MRI parameters [volume transfer constant Ktrans (min-1), enhancement fraction EF (%), and their product KEF (min-1)] were recorded at each visit, before and after treatment. Changes in pre- and post-treatment measurements of all MR parameters were assessed using Wilcoxon signed-rank tests (P<0.05 was considered significant). DCE-MRI and IVIM-DWI parameter correlations were evaluated with Spearman rank tests. Functional MR parameters were also compared against Response Evaluation Criteria In Solid Tumours v.1.1 (RECIST) evaluations. RESULTS Significant treatment-induced reductions of DCE-MRI parameters across the cohort were observed for EF (91.2 to 50.8%, P<0.001), KEF (0.095 to 0.045 min-1, P<0.001) and Ktrans (0.109 to 0.078 min-1, P=0.002). For IVIM-DWI, only D (a non-perfusion parameter) increased significantly post treatment (0.83 to 0.97 × 10-3 mm2/s, P<0.001), while perfusion-related parameters showed no change. No strong correlations were found between DCE-MRI and IVIM-DWI parameters. A moderate correlation was found, after treatment, between Ktrans and D* (r=0.60; P=0.002) and fD* (r=0.67; P<0.001). When compared to RECIST v.1.1 evaluations, KEF and D correctly identified most clinical responders, whilst non-responders were incorrectly identified. CONCLUSION IVIM-DWI perfusion-related parameters showed limited sensitivity to the anti-angiogenic effects of Regorafenib treatment in colorectal liver metastases and showed low correlation with DCE-MRI parameters, despite profound and significant post-treatment reductions in DCE-MRI measurements. TRIAL REGISTRATION NCT03010722 clinicaltrials.gov; registration date 6th January 2015.
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Affiliation(s)
- Mihaela Rata
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.
- Royal Marsden NHS Foundation Trust & Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK.
| | - Khurum Khan
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - David J Collins
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Maria Antonietta Bali
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - James d'Arcy
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Cancer Research UK National Cancer Imaging Translational Accelerator (NCITA), London, United Kingdom
| | - Jessica M Winfield
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Simona Picchia
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nicola Valeri
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
- Centre for Evolution and Cancer, The Institute of Cancer Research, London and Sutton, United Kingdom
- Division of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Ian Chau
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - David Cunningham
- Department of Medicine, GI and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Martin O Leach
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Matthew R Orton
- Department of Radiology, MRI Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
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Kristeleit R, Evans J, Molife LR, Tunariu N, Shaw H, Slater S, Haris NRM, Brown NF, Forster MD, Diamantis N, Rulach R, Greystoke A, Asghar U, Rata M, Anderson S, Bachmann F, Hannah A, Kaindl T, Lane HA, Larger PJ, Schmitt-Hoffmann A, Engelhardt M, Tzankov A, Plummer R, Lopez J. Phase 1/2a trial of intravenous BAL101553, a novel controller of the spindle assembly checkpoint, in advanced solid tumours. Br J Cancer 2020; 123:1360-1369. [PMID: 32741975 PMCID: PMC7591872 DOI: 10.1038/s41416-020-1010-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND BAL101553 (lisavanbulin), the lysine prodrug of BAL27862 (avanbulin), exhibits broad anti-proliferative activity in human cancer models refractory to clinically relevant microtubule-targeting agents. METHODS This two-part, open-label, phase 1/2a study aimed to determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of 2-h infusion of BAL101553 in adults with advanced or recurrent solid tumours. The MTD was determined using a modified accelerated titration design in phase I. Patients received BAL101553 at the MTD and at lower doses in the phase 2a expansion to characterise safety and efficacy and to determine the recommended phase 2 dose (RP2D). RESULTS Seventy-three patients received BAL101553 at doses of 15-80 mg/m2 (phase 1, n = 24; phase 2a, n = 49). The MTD was 60 mg/m2; DLTs observed at doses ≥60 mg/m2 were reversible Grade 2-3 gait disturbance with Grade 2 peripheral sensory neuropathy. In phase 2a, asymptomatic myocardial injury was observed at doses ≥45 mg/m2. The RP2D for 2-h intravenous infusion was 30 mg/m2. The overall disease control rate was 26.3% in the efficacy population. CONCLUSIONS The RP2D for 2-h infusion of BAL101553 was well tolerated. Dose-limiting neurological and myocardial side effects were consistent with the agent's vascular-disrupting properties. CLINICAL TRIAL REGISTRATION EudraCT: 2010-024237-23.
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Affiliation(s)
- Rebecca Kristeleit
- Department of Oncology, Guys and St Thomas' NHS Foundation Trust, London, UK.
- National Institute for Health Research, University College London Hospitals Clinical Research Facility, London, UK.
| | - Jeffry Evans
- University of Glasgow, Glasgow, UK
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - L Rhoda Molife
- Drug Development Unit, The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Nina Tunariu
- Drug Development Unit, The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Heather Shaw
- National Institute for Health Research, University College London Hospitals Clinical Research Facility, London, UK
| | - Sarah Slater
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Noor R Md Haris
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - Nicholas F Brown
- National Institute for Health Research, University College London Hospitals Clinical Research Facility, London, UK
| | - Martin D Forster
- National Institute for Health Research, University College London Hospitals Clinical Research Facility, London, UK
| | - Nikolaos Diamantis
- Drug Development Unit, The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Robert Rulach
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Alastair Greystoke
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Uzma Asghar
- National Institute for Health Research, University College London Hospitals Clinical Research Facility, London, UK
| | - Mihaela Rata
- Radiotherapy and Imaging Unit, Institute of Cancer Research and Royal Marsden Hospital, Sutton, UK
| | | | - Felix Bachmann
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Alison Hannah
- Oncology Clinical Trial Consulting, Sebastopol, CA, USA
| | - Thomas Kaindl
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Heidi A Lane
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | | | | | | | | | - Ruth Plummer
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Juanita Lopez
- Drug Development Unit, The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
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8
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Kaiser MF, Boyd K, Koh D, Rata M, Blackledge M, Messiou C. Improving real-world myeloma patient access to whole body MRI through "open-access" knowledge sharing: The UK experience. EJHaem 2020; 1:361-363. [PMID: 35847719 PMCID: PMC9176055 DOI: 10.1002/jha2.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Martin F Kaiser
- Division of Molecular PathologyThe Institute of Cancer ResearchLondonUK
- Department of HaematologyThe Royal Marsden HospitalLondonUK
| | - Kevin Boyd
- Department of HaematologyThe Royal Marsden HospitalLondonUK
| | - Dow‐Mu Koh
- Department of RadiologyRoyal Marsden Hospital and Institute of Cancer ResearchLondonUK
| | - Mihaela Rata
- Department of RadiologyRoyal Marsden Hospital and Institute of Cancer ResearchLondonUK
| | | | - Christina Messiou
- Department of RadiologyRoyal Marsden Hospital and Institute of Cancer ResearchLondonUK
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9
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Cassan S, Rata M, Vallenet C, Fromage P, Champly F, Broin P, Peribois G, Sierra V, Lutz C, Mangin L, Savary D, Ageron FX, Belle L. Early inter-hospital transfer of patients with myocardial infarction without a doctor, paramedic or nurse on board: results from a French regional emergency care network. BMC Emerg Med 2019; 19:60. [PMID: 31660873 PMCID: PMC6819338 DOI: 10.1186/s12873-019-0280-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/26/2018] [Accepted: 04/29/2019] [Indexed: 12/22/2022] Open
Abstract
Background In France, patients with acute coronary syndromes (ACS) are usually transferred from remote hospitals to percutaneous coronary intervention (PCI) centres in mobile intensive care units (MICUs) with on-board medical staff. They are then returned to the remote hospitals by MICU 48 h after PCI. However, MICU transportation and beds in a PCI centre are in short supply. Therefore, we investigated clinical outcomes among intermediate-risk ACS patients who were transferred in private ambulances without an on-board medic or paramedic; and returned to the remote hospital sooner after PCI. Methods In the French Alps, the RESURCOR network manages ‘SCA-Alp’ transfers using strict management protocols in ambulances with trained drivers and automatic external defibrillators, but without heart rhythm monitoring. We conducted an observational retrospective study that assessed outcomes (death and emergency return to the PCI centre within 48 h) in patients transferred using SCA-Alp. Our population comprised stabilized patients with ST-segment elevation myocardial infarction (STEMI) who returned to the remote hospital within 24–48 h of PCI, and uncomplicated patients with non-ST-segment elevation myocardial infarction (NSTEMI) within 24–72 h of symptom onset who come from and returned to (‘round-trip’) the remote hospital on the day of PCI (return < 12 h after PCI). Results Between 2010 and 2014, 101 STEMI and 490 NSTEMI patients were transferred using SCA-Alp. No adverse events occurred during transportation and no deaths were reported. Two of 591 patients (0.3% [95% confidence interval 0.1–1.4%]) experienced a stent thrombosis within 48 h of PCI that required a second urgent PCI; both were event free at 6-month follow-up. Conclusions Inter-hospital transfer using SCA-Alp is associated with low event rates in intermediate-risk ACS patients, allowing a more streamlined use of medical facilities and freeing-up of beds in PCI centres.
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Affiliation(s)
- Sebastien Cassan
- Department of Cardiology and Emergency Department, Centre Hospitalier Alpes-Leman, Annemasse, France
| | - Mihaela Rata
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Claire Vallenet
- Department of Cardiology and Emergency Department, Centre Hospitalier Alpes-Leman, Annemasse, France
| | - Philippe Fromage
- Department of Cardiology and Emergency Department, Centre Hospitalier Alpes-Leman, Annemasse, France
| | - Frederic Champly
- Department of Cardiology and Emergency Department, Centre Hospitalier de Sallanches, Sallanches, France
| | - Patrick Broin
- Department of Cardiology and Emergency Department, Centre Hospitalier de Sallanches, Sallanches, France
| | - Guillaume Peribois
- Department of Cardiology and Emergency Department, Centre Hospitalier de Thonon, Thonon, France
| | - Valerie Sierra
- Department of Cardiology and Emergency Department, Centre Hospitalier de Thonon, Thonon, France
| | - Cedric Lutz
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Lionel Mangin
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Dominique Savary
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - François-Xavier Ageron
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France
| | - Loic Belle
- Department of Cardiology and Emergency Department, Centre Hospitalier Annecy-Genevois, Annecy, France.
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10
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Gurney-Champion OJ, Collins DJ, Wetscherek A, Rata M, Klaassen R, van Laarhoven HWM, Harrington KJ, Oelfke U, Orton MR. Erratum: Principal component analysis for fast and model-free denoising of multi b-value diffusion-weighted MR images (2019 Phys. Med. Biol. 64 105015). Phys Med Biol 2019. [DOI: 10.1088/1361-6560/ab318a] [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: 11/12/2022]
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11
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Gurney-Champion OJ, Collins DJ, Wetscherek A, Rata M, Klaassen R, van Laarhoven HWM, Harrington KJ, Oelfke U, Orton MR. Principal component analysis fosr fast and model-free denoising of multi b-value diffusion-weighted MR images. Phys Med Biol 2019; 64:105015. [PMID: 30965296 PMCID: PMC7655121 DOI: 10.1088/1361-6560/ab1786] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/18/2019] [Accepted: 04/09/2019] [Indexed: 02/08/2023]
Abstract
Despite the utility of tumour characterisation using quantitative parameter maps from multi-b-value diffusion-weighted MRI (DWI), clinicians often prefer the use of the image with highest diffusion-weighting (b-value), for instance for defining regions of interest (ROIs). However, these images are typically degraded by noise, as they do not utilize the information from the full acquisition. We present a principal component analysis (PCA) approach for model-free denoising of DWI data. PCA-denoising was compared to synthetic MRI, where a diffusion model is fitted for each voxel and a denoised image at a given b-value is generated from the model fit. A quantitative comparison of systematic and random errors was performed on data simulated using several diffusion models (mono-exponential, bi-exponential, stretched-exponential and kurtosis). A qualitative visual comparison was also performed for in vivo images in six healthy volunteers and three pancreatic cancer patients. In simulations, the reduction in random errors from PCA-denoising was substantial (up to 55%) and similar to synthetic MRI (up to 53%). Model-based synthetic MRI denoising resulted in substantial (up to 29% of signal) systematic errors, whereas PCA-denoising was able to denoise without introducing systematic errors (less than 2%). In vivo, the signal-to-noise ratio (SNR) and sharpness of PCA-denoised images were superior to synthetic MRI, resulting in clearer tumour boundaries. In the presence of motion, PCA-denoising did not cause image blurring, unlike image averaging or synthetic MRI. Multi-b-value MRI can be denoised model-free with our PCA-denoising strategy that reduces noise to a level similar to synthetic MRI, but without introducing systematic errors associated with the synthetic MRI method.
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Affiliation(s)
- Oliver J Gurney-Champion
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - David J Collins
- Cancer Research UK Cancer Imaging Centre,
The Institute of Cancer Research and The
Royal Marsden NHS Foundation Trust, London, United
Kingdom
| | - Andreas Wetscherek
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - Mihaela Rata
- Cancer Research UK Cancer Imaging Centre,
The Institute of Cancer Research and The
Royal Marsden NHS Foundation Trust, London, United
Kingdom
| | - Remy Klaassen
- Department of Medical Oncology, Cancer Center
Amsterdam, Amsterdam UMC, University of
Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center
Amsterdam, Amsterdam UMC, University of
Amsterdam, Amsterdam, The Netherlands
| | - Kevin J Harrington
- Targeted Therapy Team, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - Uwe Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden
NHS Foundation Trust, London, United
Kingdom
| | - Matthew R Orton
- Cancer Research UK Cancer Imaging Centre,
The Institute of Cancer Research and The
Royal Marsden NHS Foundation Trust, London, United
Kingdom
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12
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Khan K, Rata M, Cunningham D, Koh DM, Tunariu N, Hahne JC, Vlachogiannis G, Hedayat S, Marchetti S, Lampis A, Damavandi MD, Lote H, Rana I, Williams A, Eccles SA, Fontana E, Collins D, Eltahir Z, Rao S, Watkins D, Starling N, Thomas J, Kalaitzaki E, Fotiadis N, Begum R, Bali M, Rugge M, Temple E, Fassan M, Chau I, Braconi C, Valeri N. Functional imaging and circulating biomarkers of response to regorafenib in treatment-refractory metastatic colorectal cancer patients in a prospective phase II study. Gut 2018; 67:1484-1492. [PMID: 28790159 PMCID: PMC6204951 DOI: 10.1136/gutjnl-2017-314178] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/16/2017] [Accepted: 05/23/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Regorafenib demonstrated efficacy in patients with metastatic colorectal cancer (mCRC). Lack of predictive biomarkers, potential toxicities and cost-effectiveness concerns highlight the unmet need for better patient selection. DESIGN Patients with RAS mutant mCRC with biopsiable metastases were enrolled in this phase II trial. Dynamic contrast-enhanced (DCE) MRI was acquired pretreatment and at day 15 post-treatment. Median values of volume transfer constant (Ktrans), enhancing fraction (EF) and their product KEF (summarised median values of Ktrans× EF) were generated. Circulating tumour (ct) DNA was collected monthly until progressive disease and tested for clonal RAS mutations by digital-droplet PCR. Tumour vasculature (CD-31) was scored by immunohistochemistry on 70 sequential tissue biopsies. RESULTS Twenty-seven patients with paired DCE-MRI scans were analysed. Median KEF decrease was 58.2%. Of the 23 patients with outcome data, >70% drop in KEF (6/23) was associated with higher disease control rate (p=0.048) measured by RECIST V. 1.1 at 2 months, improved progression-free survival (PFS) (HR 0.16 (95% CI 0.04 to 0.72), p=0.02), 4-month PFS (66.7% vs 23.5%) and overall survival (OS) (HR 0.08 (95% CI 0.01 to 0.63), p=0.02). KEF drop correlated with CD-31 reduction in sequential tissue biopsies (p=0.04). RAS mutant clones decay in ctDNA after 8 weeks of treatment was associated with better PFS (HR 0.21 (95% CI 0.06 to 0.71), p=0.01) and OS (HR 0.28 (95% CI 0.07-1.04), p=0.06). CONCLUSIONS Combining DCE-MRI and ctDNA predicts duration of anti-angiogenic response to regorafenib and may improve patient management with potential health/economic implications.
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Affiliation(s)
- Khurum Khan
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton, UK
| | - Mihaela Rata
- Division of Radiotherapy and Imaging, Cancer Research UK Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - David Cunningham
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, Cancer Research UK Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Nina Tunariu
- Division of Radiotherapy and Imaging, Cancer Research UK Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Jens C Hahne
- Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton, UK
| | - George Vlachogiannis
- Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton, UK
| | - Somaieh Hedayat
- Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton, UK
| | - Silvia Marchetti
- Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton, UK
| | - Andrea Lampis
- Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton, UK
| | | | - Hazel Lote
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton, UK
| | - Isma Rana
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Anja Williams
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Suzanne A Eccles
- Division of Cancer Therapeutics, The Institute of Cancer Research, London and Sutton, UK
| | - Elisa Fontana
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - David Collins
- Division of Radiotherapy and Imaging, Cancer Research UK Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Zakaria Eltahir
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Sheela Rao
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - David Watkins
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Naureen Starling
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Jan Thomas
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Eleftheria Kalaitzaki
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
- Department of Statistics, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Nicos Fotiadis
- Division of Radiotherapy and Imaging, Cancer Research UK Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Ruwaida Begum
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Maria Bali
- Division of Radiotherapy and Imaging, Cancer Research UK Imaging Centre, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Massimo Rugge
- Department of Medicine (DIMED) and Surgical Pathology, University of Padua, Padua, Italy
| | - Eleanor Temple
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Matteo Fassan
- Department of Medicine (DIMED) and Surgical Pathology, University of Padua, Padua, Italy
| | - Ian Chau
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
| | - Chiara Braconi
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
- Division of Cancer Therapeutics, The Institute of Cancer Research, London and Sutton, UK
| | - Nicola Valeri
- Department of Medicine, The Royal Marsden NHS Trust, London and Sutton, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton, UK
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13
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Vlachogiannis G, Hedayat S, Vatsiou A, Jamin Y, Fernández-Mateos J, Khan K, Lampis A, Eason K, Huntingford I, Burke R, Rata M, Koh DM, Tunariu N, Collins D, Hulkki-Wilson S, Ragulan C, Spiteri I, Moorcraft SY, Chau I, Rao S, Watkins D, Fotiadis N, Bali M, Darvish-Damavandi M, Lote H, Eltahir Z, Smyth EC, Begum R, Clarke PA, Hahne JC, Dowsett M, de Bono J, Workman P, Sadanandam A, Fassan M, Sansom OJ, Eccles S, Starling N, Braconi C, Sottoriva A, Robinson SP, Cunningham D, Valeri N. Patient-derived organoids model treatment response of metastatic gastrointestinal cancers. Science 2018; 359:920-926. [PMID: 29472484 PMCID: PMC6112415 DOI: 10.1126/science.aao2774] [Citation(s) in RCA: 1041] [Impact Index Per Article: 173.5] [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: 07/04/2017] [Revised: 10/26/2017] [Accepted: 01/11/2018] [Indexed: 12/20/2022]
Abstract
Patient-derived organoids (PDOs) have recently emerged as robust preclinical models; however, their potential to predict clinical outcomes in patients has remained unclear. We report on a living biobank of PDOs from metastatic, heavily pretreated colorectal and gastroesophageal cancer patients recruited in phase 1/2 clinical trials. Phenotypic and genotypic profiling of PDOs showed a high degree of similarity to the original patient tumors. Molecular profiling of tumor organoids was matched to drug-screening results, suggesting that PDOs could complement existing approaches in defining cancer vulnerabilities and improving treatment responses. We compared responses to anticancer agents ex vivo in organoids and PDO-based orthotopic mouse tumor xenograft models with the responses of the patients in clinical trials. Our data suggest that PDOs can recapitulate patient responses in the clinic and could be implemented in personalized medicine programs.
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Affiliation(s)
| | - Somaieh Hedayat
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Alexandra Vatsiou
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | - Yann Jamin
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Javier Fernández-Mateos
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | - Khurum Khan
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
- Department of Medicine, The Royal Marsden NHS Trust, London, UK
| | - Andrea Lampis
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Katherine Eason
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Ian Huntingford
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Rosemary Burke
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, UK
| | - Mihaela Rata
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - Nina Tunariu
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - David Collins
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Sanna Hulkki-Wilson
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Chanthirika Ragulan
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Inmaculada Spiteri
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | | | - Ian Chau
- Department of Medicine, The Royal Marsden NHS Trust, London, UK
| | - Sheela Rao
- Department of Medicine, The Royal Marsden NHS Trust, London, UK
| | - David Watkins
- Department of Medicine, The Royal Marsden NHS Trust, London, UK
| | - Nicos Fotiadis
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - Maria Bali
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | | | - Hazel Lote
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
- Department of Medicine, The Royal Marsden NHS Trust, London, UK
| | - Zakaria Eltahir
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | | | - Ruwaida Begum
- Department of Medicine, The Royal Marsden NHS Trust, London, UK
| | - Paul A Clarke
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, UK
| | - Jens C Hahne
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Mitchell Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital NHS Trust, London, UK
| | - Johann de Bono
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Paul Workman
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, UK
| | - Anguraj Sadanandam
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Matteo Fassan
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Italy
| | | | - Suzanne Eccles
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, UK
| | | | - Chiara Braconi
- Department of Medicine, The Royal Marsden NHS Trust, London, UK
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, UK
| | - Andrea Sottoriva
- Centre for Evolution and Cancer, The Institute of Cancer Research, London, UK
| | - Simon P Robinson
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | | | - Nicola Valeri
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.
- Department of Medicine, The Royal Marsden NHS Trust, London, UK
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14
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Khan K, Cunningham D, Vlachogiannis G, Hedayat S, Rata M, Koh DM, Tunariu N, Jamin Y, Collins D, Chau I, Rao S, Watkins D, Starling N, Peckitt C, Fotiadis N, Saffery C, Hahne J, Fassan M, Braconi C, Valeri N. Clinical and pre-clinical biomarkers of Regorafenib (REG) efficacy in metastatic colorectal cancer (mCRC) in a phase II trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.032] [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: 11/14/2022] Open
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Winfield JM, Tunariu N, Rata M, Miyazaki K, Jerome NP, Germuska M, Blackledge MD, Collins DJ, de Bono JS, Yap TA, deSouza NM, Doran SJ, Koh DM, Leach MO, Messiou C, Orton MR. Extracranial Soft-Tissue Tumors: Repeatability of Apparent Diffusion Coefficient Estimates from Diffusion-weighted MR Imaging. Radiology 2017; 284:88-99. [PMID: 28301311 PMCID: PMC6063352 DOI: 10.1148/radiol.2017161965] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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] [Indexed: 01/21/2023]
Abstract
Purpose To assess the repeatability of apparent diffusion coefficient (ADC) estimates in extracranial soft-tissue diffusion-weighted magnetic resonance imaging across a wide range of imaging protocols and patient populations. Materials and Methods Nine prospective patient studies and one prospective volunteer study, performed between 2006 and 2016 with research ethics committee approval and written informed consent from each subject, were included in this single-institution study. A total of 141 tumors and healthy organs were imaged twice (interval between repeated examinations, 45 minutes to 10 days, depending the on study) to assess the repeatability of median and mean ADC estimates. The Levene test was used to determine whether ADC repeatability differed between studies. The Pearson linear correlation coefficient was used to assess correlation between coefficient of variation (CoV) and the year the study started, study size, and volumes of tumors and healthy organs. The repeatability of ADC estimates from small, medium, and large tumors and healthy organs was assessed irrespective of study, and the Levene test was used to determine whether ADC repeatability differed between these groups. Results CoV aggregated across all studies was 4.1% (range for each study, 1.7%-6.5%). No correlation was observed between CoV and the year the study started or study size. CoV was weakly correlated with volume (r = -0.5, P = .1). Repeatability was significantly different between small, medium, and large tumors (P < .05), with the lowest CoV (2.6%) for large tumors. There was a significant difference in repeatability between studies-a difference that did not persist after the study with the largest tumors was excluded. Conclusion ADC is a robust imaging metric with excellent repeatability in extracranial soft tissues across a wide range of tumor sites, sizes, patient populations, and imaging protocol variations. Online supplemental material is available for this article.
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Affiliation(s)
- Jessica M Winfield
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Nina Tunariu
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Mihaela Rata
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Keiko Miyazaki
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Neil P Jerome
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Michael Germuska
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Matthew D Blackledge
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - David J Collins
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Johann S de Bono
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Timothy A Yap
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Nandita M deSouza
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Simon J Doran
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Dow-Mu Koh
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Martin O Leach
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Christina Messiou
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
| | - Matthew R Orton
- From the Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Division of Clinical Studies (J.S.d.B., T.A.Y.), the Institute of Cancer Research and Royal Marsden Hospital, London, England; MRI Unit (J.M.W., N.T., M.R., K.M., N.P.J., M.G., M.D.B., D.J.C., N.M.d.S., S.J.D., D.M.K., M.O.L., C.M., M.R.O.) and Drug Development Unit (J.S.d.B., T.A.Y.), the Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, England
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16
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Perez-Lopez R, Mateo J, Mossop H, Blackledge MD, Collins DJ, Rata M, Morgan VA, Macdonald A, Sandhu S, Lorente D, Rescigno P, Zafeiriou Z, Bianchini D, Porta N, Hall E, Leach MO, de Bono JS, Koh DM, Tunariu N. Diffusion-weighted Imaging as a Treatment Response Biomarker for Evaluating Bone Metastases in Prostate Cancer: A Pilot Study. Radiology 2017; 283:168-177. [PMID: 27875103 PMCID: PMC6140995 DOI: 10.1148/radiol.2016160646] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [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] [Indexed: 01/21/2023]
Abstract
Purpose To determine the usefulness of whole-body diffusion-weighted imaging (DWI) to assess the response of bone metastases to treatment in patients with metastatic castration-resistant prostate cancer (mCRPC). Materials and Methods A phase II prospective clinical trial of the poly-(adenosine diphosphate-ribose) polymerase inhibitor olaparib in mCRPC included a prospective magnetic resonance (MR) imaging substudy; the study was approved by the institutional research board, and written informed consent was obtained. Whole-body DWI was performed at baseline and after 12 weeks of olaparib administration by using 1.5-T MR imaging. Areas of abnormal signal intensity on DWI images in keeping with bone metastases were delineated to derive total diffusion volume (tDV); five target lesions were also evaluated. Associations of changes in volume of bone metastases and median apparent diffusion coefficient (ADC) with response to treatment were assessed by using the Mann-Whitney test and logistic regression; correlation with prostate-specific antigen level and circulating tumor cell count were assessed by using Spearman correlation (r). Results Twenty-one patients were included. All six responders to olaparib showed a decrease in tDV, while no decrease was observed in all nonresponders; this difference between responders and nonresponders was significant (P = .001). Increases in median ADC were associated with increased odds of response (odds ratio, 1.08; 95% confidence interval [CI]: 1.00, 1.15; P = .04). A positive association was detected between changes in tDV and best percentage change in prostate-specific antigen level and circulating tumor cell count (r = 0.63 [95% CI: 0.27, 0.83] and r = 0.77 [95% CI: 0.51, 0.90], respectively). When assessing five target lesions, decreases in volume were associated with response (odds ratio for volume increase, 0.89; 95% CI: 0.80, 0.99; P = .037). Conclusion This pilot study showed that decreases in volume and increases in median ADC of bone metastases assessed with whole-body DWI can potentially be used as indicators of response to olaparib in mCRPC. Online supplemental material is available for this article.
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Affiliation(s)
- Raquel Perez-Lopez
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Joaquin Mateo
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Helen Mossop
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Matthew D Blackledge
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - David J Collins
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Mihaela Rata
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Veronica A Morgan
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Alison Macdonald
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Shahneen Sandhu
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - David Lorente
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Pasquale Rescigno
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Zafeiris Zafeiriou
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Diletta Bianchini
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Nuria Porta
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Emma Hall
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Martin O Leach
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Johann S de Bono
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Dow-Mu Koh
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
| | - Nina Tunariu
- From the Inst of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Therapeutics Div, 15 Cotswold Rd, Sutton SM2 5NG, England
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Khan KH, Rata M, Koh DM, Tunariu N, Vlachogiannis G, Hahne J, Jamin Y, Collins DJ, Chau I, Rao S, Watkins DJ, Starling N, Kalaitzaki E, Fotiadis N, Begum R, Temple E, Fassan M, Braconi C, Cunningham D, Valeri N. Magnetic resonance Imaging (MRI), liquid biopsies, and patient derived organoids (PDOs) as biomarkers of response to regorafenib (REG) in treatment-refractory metastatic colorectal cancer (mCRC) patients (pts). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
613 Background: REG demonstrated efficacy in pre-treated mCRC pts. Lack of predictive biomarkers, potential toxicities and cost/effectiveness concerns highlight the unmet need for better patient selection. Methods: RAS mutant mCRC pts with biopsiable metastases were enrolled in this phase II trial. Tissue biopsies (6-12 cores) were obtained at baseline (BL), after 2 months if stable disease (SD) and at disease progression (PD). Dynamic contrast enhanced (DCE) MRI was acquired pre and at day 15 post-treatment. Median values of volume transfer constant (Ktrans) and enhancing fraction (EF) [K-trans*EF/100] were generated. Circulating tumour (ct)DNA was collected monthly until PD and tested for clonal RAS mutations by digital droplet PCR. PDOs derived from responders and non-responders pts were implanted orthotopically in the liver of mice and treated with REG for 5 days. Changes in tumour and fractional blood volume (fBV) were monitored by oxygen-enhanced MRI. Results: mCRC pts (n = 27) with paired MRI scans were analysed; a single target lesion per pt was chosen (25 liver and 2 pelvic metastases). Median K-trans*EF/100 product decrease was 58.2%. In the 23 analysable pts (4 received < 1 cycle of treatment due to toxicities), > 70% drop in K-trans*EF/100 (8/23) was associated with higher disease control rate (6/6 vs. 0/6, p = 0.048) measured by RECIST 1.1 at 2 months, improved progression free survival (PFS) [HR = 0.24 (0.07-0.86), p = 0.03], and 4-month PFS (58.3% VS 21.2%). Sequential tissue biopsies analysis confirmed reduction in CD31 in pts with K-trans*EF/100 drop. RAS mutant clones decay in ctDNA after 8 weeks of treatment was associated with better PFS [HR = 0.25 (0.08 - 0.83), p = 0.02] independently of K-trans*EF/100 drop. PDOs xeno-transplants treated with REG compared to controls had significant lower tumour fBV (4.5 VS 10.6, p = 0.03) and lower microvascular density measured by CD31 staining (4.3 VS 8.9, p = 0.02). Conclusions: Combining DCE MRI and ctDNA predicts depth and duration of anti-angiogenic response to REG monotherapy and may improve pt selection with potential health/economic implications. Clinical trial information: 201400357951.
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Affiliation(s)
- Khurum Hayat Khan
- The Royal Marsden NHS Foundation Trust, Sutton Surrey, United Kingdom
| | - Mihaela Rata
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Dow-Mu Koh
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Nina Tunariu
- Drug Development Unit, Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | | | - Jens Hahne
- Institute of Cancer Research, London, United Kingdom
| | - Yann Jamin
- Institute of Cancer Research, London, United Kingdom
| | - David J. Collins
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Ian Chau
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Sheela Rao
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Nicos Fotiadis
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ruwaida Begum
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Eleanor Temple
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Nicola Valeri
- Institute of Cancer Research, London, United Kingdom
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18
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Cheng L, Blackledge MD, Collins DJ, Orton MR, Jerome NP, Feiweier T, Rata M, Morgan V, Tunariu N, Leach MO, Koh DM. T 2-adjusted computed diffusion-weighted imaging: A novel method to enhance tumour visualisation. Comput Biol Med 2016; 79:92-98. [PMID: 27770679 DOI: 10.1016/j.compbiomed.2016.09.022] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/28/2016] [Accepted: 09/30/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE To introduce T2-adjusted computed DWI (T2-cDWI), a method that provides synthetic images at arbitrary b-values and echo times (TEs) that improve tissue contrast by removing or increasing T2 contrast in diffusion-weighted images. MATERIALS AND METHODS In addition to the standard DWI acquisition protocol T2-weighted echo-planar images at multiple (≥2) echo times were acquired. This allows voxelwise estimation of apparent diffusion coefficient (ADC) and T2 values, permitting synthetic images to be generated at any chosen b-value and echo time. An analytical model is derived for the noise properties in T2-cDWI, and validated using a diffusion test-object. Furthermore, we present T2-cDWI in two example clinical case studies: (i) a patient with mesothelioma demonstrating multiple disease tissue compartments and (ii) a patient with primary ovarian cancer demonstrating solid and cystic disease compartments. RESULTS Measured image noise in T2-cDWI from phantom experiments conformed to the analytical model and demonstrated that T2-cDWI at high computed b-value/TE combinations achieves lower noise compared with conventional DWI. In patients, T2-cDWI with low b-value and long TE enhanced fluid signal while suppressing solid tumour components. Conversely, large b-values and short TEs overcome T2 shine-through effects and increase the contrast between tumour and fluid compared with conventional high-b-value DW images. CONCLUSION T2-cDWI is a promising clinical tool for improving image signal-to-noise, image contrast, and tumour detection through suppression of T2 shine-through effects.
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Affiliation(s)
- Lin Cheng
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Matthew D Blackledge
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
| | - David J Collins
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Matthew R Orton
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Neil P Jerome
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | | | - Mihaela Rata
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | | | - Nina Tunariu
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiology, Royal Marsden Hospital, Sutton, UK
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Rata M, Collins DJ, Darcy J, Messiou C, Tunariu N, Desouza N, Young H, Leach MO, Orton MR. Assessment of repeatability and treatment response in early phase clinical trials using DCE-MRI: comparison of parametric analysis using MR- and CT-derived arterial input functions. Eur Radiol 2016; 26:1991-8. [PMID: 26385804 PMCID: PMC4902841 DOI: 10.1007/s00330-015-4012-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/07/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Pharmacokinetic (PK) modelling of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data requires a reliable measure of the arterial input function (AIF) to robustly characterise tumour vascular properties. This study compared repeatability and treatment-response effects of DCE-MRI-derived PK parameters using a population-averaged AIF and three patient-specific AIFs derived from pre-bolus MRI, DCE-MRI and dynamic contrast computed tomography (DC-CT) data. METHODS The four approaches were compared in 13 patients with abdominal metastases. Baseline repeatability [Bland-Altman statistics; coefficient of variation (CoV)], cohort percentage change and p value (paired t test) and number of patients with significant DCE-MRI parameter change post-treatment (limits of agreement) were assessed. RESULTS Individual AIFs were obtained for all 13 patients with pre-bolus MRI and DC-CT-derived AIFs, but only 10/13 patients had AIFs measurable from DCE-MRI data. The best CoV (7.5 %) of the transfer coefficient between blood plasma and extravascular extracellular space (K (trans)) was obtained using a population-averaged AIF. All four AIF methods detected significant treatment changes: the most significant was the DC-CT-derived AIF. The population-based AIF was similar to or better than the pre-bolus and DCE-MRI-derived AIFs. CONCLUSIONS A population-based AIF is the recommended approach for measuring cohort and individual effects since it has the best repeatability and none of the PK parameters derived using measured AIFs demonstrated an improvement in treatment sensitivity. KEY POINTS • Pharmacokinetic modelling of DCE-MRI data requires a reliable measure of AIF. • Individual MRI-DCE-derived AIFs cannot reliably be extracted from patients. • All four AIF methods detected significant K (trans) changes after treatment. • A population-based AIF can be recommended for measuring cohort treatment responses in trials.
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Affiliation(s)
- Mihaela Rata
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - David J Collins
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - James Darcy
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Christina Messiou
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Nina Tunariu
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Nandita Desouza
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | - Helen Young
- Early Clinical Development, AstraZeneca, Macclesfield, Cheshire, UK
| | - Martin O Leach
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden Hospital, London, UK.
- CRUK Cancer Imaging Centre, MRI Unit, Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Matthew R Orton
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research and Royal Marsden Hospital, London, UK
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Khan KH, Rata M, Koh DM, Tunariu N, Collins DJ, Chau I, Watkins DJ, Starling N, Rao S, Peckitt C, Fotiadis N, Begum R, Saffery C, Thomas J, Gerlinger M, Valeri N, Cunningham D. A prospective translational study investigating molecular predictors of resistance and response to regorafenib (REG) monotherapy in RAS mutant (mt) metastatic colorectal cancer (mCRC): Initial magnetic resonance imaging (MRI) sub-study result. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
580 Background: REG that has single agent efficacy in patients (pts) with refractory mCRC, is known to have anti-angiogenic activities. The benefit of REG in unselected pts is modest. Thus, the identification of predictive biomarkers is critical for treatment stratification. PROSPECT-R study aims to identify genetic and radiological mechanisms of primary and acquired REG resistance in RAS mt mCRC patients. Methods: Multiparametric MRI studies including dynamic contrast enhancement (DCE)-MRI and diffusion weighted imaging (DWI) were acquired pre- and at day 15 post-treatment on a 1.5T Siemens Avanto MR scanner. Regions of interest of the entire chosen target metastatic lesion were drawn by a senior radiologist and the following imaging parameters were generated: volume transfer constant (Ktrans) derived from a pharmacokinetic analysis based on the extended Kety model and apparent diffusion coefficient (ADC) calculated using a mono-exponential fitting algorithm; median values of ADC and Ktrans were reported. Results: The first seven enrolled pts were analysed; a single target lesion per patient was chosen (5 liver and 2 pelvic metastases). At day 15 post treatment, a marked decrease (68-81%) of median tumour Ktrans was observed in 4 out of 7 pts; the remaining 3 patients showed no significant median Ktrans change (-36 to + 17%). Overall, the cohort average Ktrans decreased from 0.17 to 0.07 min-1(58%). No significant ADC changes were observed at day 15. Of the 4 pts with Ktrans reduction on day 15, 1 achieved RECIST 1.1 partial response (38% reduction in target lesions), 2 had stable disease and 1 progressed, based on CT assessments performed at 8 weeks of REG therapy; 3/7 pts with no Ktrans change progressed within 2 months of initiating REG. When modified Choi criteria were applied, 3/4 pts with Ktrans reduction were classified as responders. Conclusions: REG may have early anti-angiogenic affects; DCE-MRI could be a potential predicting biomarker in pts treated with REG. Further analysis within PROSPECT-R may elucidate genetic biomarkers to validate these findings. Clinical trial information: EUDRACT No: 2014- 003579-51.
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Affiliation(s)
- Khurum Hayat Khan
- The Royal Marsden NHS Foundation Trust, Sutton Surrey, United Kingdom
| | - Mihaela Rata
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Dow-Mu Koh
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Nina Tunariu
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J. Collins
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Ian Chau
- Royal Marsden Hospital, London, United Kingdom
| | | | | | - Sheela Rao
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Nicos Fotiadis
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Ruwaida Begum
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Claire Saffery
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Janet Thomas
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Marco Gerlinger
- Translational Oncogenomics Lab, Institute of Cancer Research, London, United Kingdom
| | - Nicola Valeri
- Institute of Cancer Research, London, United Kingdom
| | - David Cunningham
- The Royal Marsden and The Institute of Cancer Research, London, United Kingdom
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Paziuc A, Mangin L, Isaps A, Rata M, Fafitte B, Vanwalledhem S, Madiot H, Ricard C, Georges JL, Belle L. 0453: Incidence of radiation-induced skin lesions after percutaneous coronary intervention. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30010-6] [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: 11/16/2022]
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Lopez RP, Lorente D, Mateo J, Blackledge M, Sideris S, Zafeiriou Z, Smith A, Ferraldeschi R, Rescigno P, Rata M, Naumann U, Collins D, Attard G, Leach M, Koh D, de Bono J, Tunariu N. Prognostic Relevance of Imaging Bone Metastases By Whole Body Diffusion-Weighted Magnetic Resonance Imaging (Wbdwi) in Metastatic Castration-Resistant Prostate Cancer (Mcrpc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.45] [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: 11/14/2022] Open
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Rata M, Giles SL, deSouza NM, Leach MO, Payne GS. Comparison of three reference methods for the measurement of intracellular pH using 31P MRS in healthy volunteers and patients with lymphoma. NMR Biomed 2014; 27:158-62. [PMID: 24738141 PMCID: PMC4290015 DOI: 10.1002/nbm.3047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 06/03/2023]
Abstract
31P magnetic resonance spectroscopy (31P MRS) can measure intracellular pH (pHi) using the chemical shift difference between pH-dependent inorganic phosphate (Pi) and a pH-independent reference peak. This study compared three different frequency reference peaks [phosphocreatine (PCr), α resonance of adenosine triphosphate (αATP) and water (using 1H MRS)] in a cohort of 10 volunteers and eight patients with non-Hodgkin's lymphoma (NHL). Well-resolved chemical shift imaging (CSI) spectra were acquired on a 1.5T scanner for muscle, liver and tumour. The pH was calculated for all volunteers and patients using the available methods. The consistency of the resulting pH was evaluated. The direct Pi–PCr method was best for those spectra with a very well-defined PCr, such as muscle (pH=7.05 ± 0.02). In liver, the Pi–αATP method gave more consistent results (pH=7.30 ± 0.06) than the calibrated water-based method (pH=7.27 ± 0.11). In NHL nodes, the measured pH using the Pi–αATP method was 7.25 ± 0.12. Given that the measured range includes some biological variation in individual patients, treatment-related changes of the order of 0.1 pH units should be detectable.
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Rata M, Birlea V, Murillo A, Paquet C, Cotton F, Salomir R. Endoluminal MR-guided ultrasonic applicator embedding cylindrical phased-array transducers and opposed-solenoid detection coil. Magn Reson Med 2014; 73:417-26. [PMID: 24478117 DOI: 10.1002/mrm.25099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 08/09/2013] [Revised: 11/18/2013] [Accepted: 12/07/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE MR-guided high-intensity contact ultrasound (HICU) was suggested as an alternative therapy for esophageal and rectal cancer. To offer high-quality MR guidance, two prototypes of receive-only opposed-solenoid coil were integrated with 64-element cylindrical phased-array ultrasound transducers (rectal/esophageal). METHODS The design of integrated coils took into account the transducer geometry (360° acoustic window within endoluminal space). The rectal coil was sealed on a plastic support and placed reversibly on the transducer head. The esophageal coil was fully embedded within the transducer head, resulting in one indivisible device. Comparison of integrated versus external coils was performed on a clinical 1.5T scanner. RESULTS The integrated coils showed higher sensitivity compared with the standard extracorporeal coil with factors of up to 7.5 (rectal applicator) and 3.3 (esophageal applicator). High-resolution MR images for both anatomy (voxel 0.4 × 0.4 × 5 mm(3)) and thermometry (voxel 0.75 × 0.75 × 8 mm(3), 2 s/image) were acquired in vivo with the rectal endoscopic device. The temperature feedback loop accurately controlled multiple control points over the region of interest. CONCLUSION This study showed significant improvement of MR data quality using endoluminal integrated coils versus standard external coil. Inframillimeter spatial resolution and accurate feedback control of MR-guided HICU thermotherapy were achieved.
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Affiliation(s)
- Mihaela Rata
- INSERM, Therapeutic Applications of Ultrasound, U556 (currently LabTAU - U1032), Université de Lyon, Lyon, F-69003, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, F-69003, France
| | - Vlad Birlea
- INSERM, Therapeutic Applications of Ultrasound, U556 (currently LabTAU - U1032), Université de Lyon, Lyon, F-69003, France.,Babes-Bolyai University, Faculty of Physics, Cluj-Napoca, Romania
| | - Adriana Murillo
- INSERM, Therapeutic Applications of Ultrasound, U556 (currently LabTAU - U1032), Université de Lyon, Lyon, F-69003, France
| | - Christian Paquet
- Université de Lyon, VetAgro Sup, EA 4174, Marcy l'Etoile, F-69280, France
| | - François Cotton
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, F-69003, France.,MR Unit, Radiology Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, F-69495, France
| | - Rares Salomir
- INSERM, Therapeutic Applications of Ultrasound, U556 (currently LabTAU - U1032), Université de Lyon, Lyon, F-69003, France.,Radiology Department, Faculty of Medicine, University of Geneva, Geneva, CH-1211, Switzerland
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Salomir R, Rata M, Cadis D, Petrusca L, Auboiroux V, Cotton F. Endocavitary thermal therapy by MRI-guided phased-array contact ultrasound: experimental and numerical studies on the multi-input single-output PID temperature controller's convergence and stability. Med Phys 2010; 36:4726-41. [PMID: 19928104 DOI: 10.1118/1.3215534] [Citation(s) in RCA: 12] [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] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Endocavitary high intensity contact ultrasound (HICU) may offer interesting therapeutic potential for fighting localized cancer in esophageal or rectal wall. On-line MR guidance of the thermotherapy permits both excellent targeting of the pathological volume and accurate preoperatory monitoring of the temperature elevation. In this article, the authors address the issue of the automatic temperature control for endocavitary phased-array HICU and propose a tailor-made thermal model for this specific application. The convergence and stability of the feedback loop were investigated against tuning errors in the controller's parameters and against input noise, through ex vivo experimental studies and through numerical simulations in which nonlinear response of tissue was considered as expected in vivo. METHODS An MR-compatible, 64-element, cooled-tip, endorectal cylindrical phased-array applicator of contact ultrasound was integrated with fast MR thermometry to provide automatic feedback control of the temperature evolution. An appropriate phase law was applied per set of eight adjacent transducers to generate a quasiplanar wave, or a slightly convergent one (over the circular dimension). A 2D physical model, compatible with on-line numerical implementation, took into account (1) the ultrasound-mediated energy deposition, (2) the heat diffusion in tissue, and (3) the heat sink effect in the tissue adjacent to the tip-cooling balloon. This linear model was coupled to a PID compensation algorithm to obtain a multi-input single-output static-tuning temperature controller. Either the temperature at one static point in space (situated on the symmetry axis of the beam) or the maximum temperature in a user-defined ROI was tracked according to a predefined target curve. The convergence domain in the space of controller's parameters was experimentally explored ex vivo. The behavior of the static-tuning PID controller was numerically simulated based on a discrete-time iterative solution of the bioheat transfer equation in 3D and considering temperature-dependent ultrasound absorption and blood perfusion. RESULTS The intrinsic accuracy of the implemented controller was approximately 1% in ex vivo trials when providing correct estimates for energy deposition and heat diffusivity. Moreover, the feedback loop demonstrated excellent convergence and stability over a wide range of the controller's parameters, deliberately set to erroneous values. In the extreme case of strong underestimation of the ultrasound energy deposition in tissue, the temperature tracking curve alone, at the initial stage of the MR-controlled HICU treatment, was not a sufficient indicator for a globally stable behavior of the feedback loop. Our simulations predicted that the controller would be able to compensate for tissue perfusion and for temperature-dependent ultrasound absorption, although these effects were not included in the controller's equation. The explicit pattern of acoustic field was not required as input information for the controller, avoiding time-consuming numerical operations. CONCLUSIONS The study demonstrated the potential advantages of PID-based automatic temperature control adapted to phased-array MR-guided HICU therapy. Further studies will address the integration of this ultrasound device with a miniature RF coil for high resolution MRI and, subsequently, the experimental behavior of the controller in vivo.
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Affiliation(s)
- Rares Salomir
- Inserm, U556, Lyon F-69003, France and Université de Lyon, Lyon F-69003, France.
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Petrusca L, Salomir R, Milleret R, Pichot O, Rata M, Cotton F, Chapelon JY. Experimental investigation of thermal effects in HIFU-based external valvuloplasty with a non-spherical transducer, using high-resolution MR thermometry. Phys Med Biol 2009; 54:5123-38. [DOI: 10.1088/0031-9155/54/17/004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Rata M, Salomir R, Umathum R, Jenne J, Lafon C, Cotton F, Bock M. Endoluminal ultrasound applicator with an integrated RF coil for high-resolution magnetic resonance imaging-guided high-intensity contact ultrasound thermotherapy. Phys Med Biol 2008; 53:6549-67. [DOI: 10.1088/0031-9155/53/22/017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Salomir R, Rata M, Lafon C, Cotton F, Anne-Sophie-Delemazure, Palussiere J, Chapelon JY. Automatic feedback control of the temperature for MRI-guided therapeutic ultrasound. ACTA ACUST UNITED AC 2007; 2007:222-5. [DOI: 10.1109/iembs.2007.4352263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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