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Jeong D, Morse B, Polk SL, Chen DT, Li J, Hodul P, Centeno BA, Costello J, Jiang K, Machado S, El Naqa I, Farah PT, Huynh T, Raghunand N, Mok S, Dam A, Malafa M, Qayyum A, Fleming JB, Permuth JB. Pancreatic Cyst Size Measurement on Magnetic Resonance Imaging Compared to Pathology. Cancers (Basel) 2024; 16:206. [PMID: 38201633 PMCID: PMC10778543 DOI: 10.3390/cancers16010206] [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: 11/28/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND While multiple cyst features are evaluated for stratifying pancreatic intraductal papillary mucinous neoplasms (IPMN), cyst size is an important factor that can influence treatment strategies. When magnetic resonance imaging (MRI) is used to evaluate IPMNs, no universally accepted sequence provides optimal size measurements. T2-weighted coronal/axial have been suggested as primary measurement sequences; however, it remains unknown how well these and maximum all-sequence diameter measurements correlate with pathology size. This study aims to compare agreement and bias between IPMN long-axis measurements on seven commonly obtained MRI sequences with pathologic size measurements. METHODS This retrospective cohort included surgically resected IPMN cases with preoperative MRI exams. Long-axis diameter tumor measurements and the presence of worrisome features and/orhigh-risk stigmata were noted on all seven MRI sequences. MRI size and pathology agreement and MRI inter-observer agreement involved concordance correlation coefficient (CCC) and intraclass correlation coefficient (ICC), respectively. The presence of worrisome features and high-risk stigmata were compared to the tumor grade using kappa analysis. The Bland-Altman analysis assessed the systematic bias between MRI-size and pathology. RESULTS In 52 patients (age 68 ± 13 years, 22 males), MRI sequences produced mean long-axis tumor measurements from 2.45-2.65 cm. The maximum MRI lesion size had a strong agreement with pathology (CCC = 0.82 (95% CI: 0.71-0.89)). The maximum IPMN size was typically observed on the axial T1 arterial post-contrast and MRCP coronal series and overestimated size versus pathology with bias +0.34 cm. The radiologist interobserver agreement reached ICCs 0.74 to 0.91 on the MRI sequences. CONCLUSION The maximum MRI IPMN size strongly correlated with but tended to overestimate the length compared to the pathology, potentially related to formalin tissue shrinkage during tissue processing.
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Affiliation(s)
- Daniel Jeong
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.M.); (J.C.); (A.Q.)
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 3011 Holly Drive, Tampa, FL 33612, USA;
| | - Brian Morse
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.M.); (J.C.); (A.Q.)
| | - Stuart Lane Polk
- College of Medicine, University of South Florida, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Dung-Tsa Chen
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (D.-T.C.); (J.L.)
| | - Jiannong Li
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (D.-T.C.); (J.L.)
| | - Pamela Hodul
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
| | - Barbara A. Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.A.C.); (K.J.)
| | - James Costello
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.M.); (J.C.); (A.Q.)
| | - Kun Jiang
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.A.C.); (K.J.)
| | - Sebastian Machado
- Department of Clinical Science, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (S.M.); (P.T.F.)
| | - Issam El Naqa
- Department of Machine Learning, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Paola T. Farah
- Department of Clinical Science, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (S.M.); (P.T.F.)
| | - Tri Huynh
- College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA;
| | - Natarajan Raghunand
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Shaffer Mok
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
| | - Aamir Dam
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
| | - Mokenge Malafa
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
| | - Aliya Qayyum
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (B.M.); (J.C.); (A.Q.)
| | - Jason B. Fleming
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
| | - Jennifer B. Permuth
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, 3011 Holly Drive, Tampa, FL 33612, USA;
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; (P.H.); (S.M.); (A.D.); (M.M.); (J.B.F.)
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Ravi H, Hawkins SH, Stringfield O, Pereira M, Chen DT, Enderling H, Michael Yu HH, Arrington JA, Sahebjam S, Raghunand N. Rules-based Volumetric Segmentation of Multiparametric MRI for Response Assessment in Recurrent High-Grade Glioma. Res Sq 2023:rs.3.rs-3318286. [PMID: 37790451 PMCID: PMC10543497 DOI: 10.21203/rs.3.rs-3318286/v1] [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] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
We report domain knowledge-based rules for assigning voxels in brain multiparametric MRI (mpMRI) to distinct tissuetypes based on their appearance on Apparent Diffusion Coefficient of water (ADC) maps, T1-weighted unenhanced and contrast-enhanced, T2-weighted, and Fluid-Attenuated Inversion Recovery images. The development dataset comprised mpMRI of 18 participants with preoperative high-grade glioma (HGG), recurrent HGG (rHGG), and brain metastases. External validation was performed on mpMRI of 235 HGG participants in the BraTS 2020 training dataset. The treatment dataset comprised serial mpMRI of 32 participants (total 231 scan dates) in a clinical trial of immunoradiotherapy in rHGG (NCT02313272). Pixel intensity-based rules for segmenting contrast-enhancing tumor (CE), hemorrhage, Fluid, non-enhancing tumor (Edema1), and leukoaraiosis (Edema2) were identified on calibrated, co-registered mpMRI images in the development dataset. On validation, rule-based CE and High FLAIR (Edema1 + Edema2) volumes were significantly correlated with ground truth volumes of enhancing tumor (R = 0.85;p < 0.001) and peritumoral edema (R = 0.87;p < 0.001), respectively. In the treatment dataset, a model combining time-on-treatment and rule-based volumes of CE and intratumoral Fluid was 82.5% accurate for predicting progression within 30 days of the scan date. An explainable decision tree applied to brain mpMRI yields validated, consistent, intratumoral tissuetype volumes suitable for quantitative response assessment in clinical trials of rHGG.
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Arias-Lorza AM, Costello JR, Hingorani SR, Von Hoff DD, Korn RL, Raghunand N. Tumor Response to Stroma-Modifying Therapy: Magnetic Resonance Imaging Findings in Early-Phase Clinical Trials of Pegvorhyaluronidase alpha (PEGPH20). Res Sq 2023:rs.3.rs-3314770. [PMID: 37720027 PMCID: PMC10503830 DOI: 10.21203/rs.3.rs-3314770/v1] [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] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Pre-clinical and clinical studies have shown that PEGPH20 depletes intratumoral hyaluronic acid (HA), which is linked to high interstitial fluid pressures and poor distribution of chemotherapies. 29 patients with metastatic advanced solid tumors received quantitative magnetic resonance imaging (qMRI) in 3 prospective clinical trials of PEGPH20, HALO-109-101 (NCT00834704), HALO-109-102 (NCT01170897), and HALO-109-201 (NCT01453153). Apparent Diffusion Coefficient of water (ADC), T1, ktrans, vp, ve, and iAUC maps were computed from qMRI acquired at baseline and ≥ 1 time point post-PEGPH20. Tumor ADC and T1 decreased, while iAUC, ktrans, vp, and ve increased, on day 1 post-PEGPH20 relative to baseline values. This is consistent with HA depletion leading to a decrease in tumor water content and an increase in perfusion, permeability, extracellular matrix space, and vascularity. Baseline parameter values that were predictive of pharmacodynamic responses were: ADC > 1.46×10-3 mm2/s (Balanced Accuracy (BA) = 72%, p < 0.01), T1 > 0.54s (BA = 82%, p < 0.01), iAUC < 9.2 mM-s (BA = 76%, p < 0.05), ktrans<0.07min-1 (BA = 72%, p = 0.2), ve<0.17 (BA = 68%, p < 0.01), and vp<0.02 (BA = 60%, p < 0.01). Further, ve<0.39 at baseline was moderately predictive of response in any parameter (BA = 65.6%, p < 0.01 averaged across patients). These qMRI biomarkers are potentially useful for guiding patient pre-selection and post-treatment follow-up in future clinical studies of PEGPH20 and other tumor stroma-modifying anti-cancer therapies.
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Ravi H, Arias-Lorza AM, Costello JR, Han HS, Jeong DK, Klinz SG, Sachdev JC, Korn RL, Raghunand N. Pretherapy Ferumoxytol-enhanced MRI to Predict Response to Liposomal Irinotecan in Metastatic Breast Cancer. Radiol Imaging Cancer 2023; 5:e220022. [PMID: 36734848 PMCID: PMC10077095 DOI: 10.1148/rycan.220022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose To investigate ferumoxytol (FMX)-enhanced MRI as a pretreatment predictor of response to liposomal irinotecan (nal-IRI) for thoracoabdominal and brain metastases in women with metastatic breast cancer (mBC). Materials and Methods In this phase 1 expansion trial (ClinicalTrials.gov identifier, NCT01770353; 27 participants), 49 thoracoabdominal (19 participants; mean age, 48 years ± 11 [SD]) and 19 brain (seven participants; mean age, 54 years ± 8) metastases were analyzed on MR images acquired before, 1-4 hours after, and 16-24 hours after FMX administration. In thoracoabdominal metastases, tumor transverse relaxation rate (R*2) was normalized to the mean R*2 in the spleen (rR*2), and the tumor histogram metric rR*2,N, representing the average of rR*2 in voxels above the nth percentile, was computed. In brain metastases, a novel compartmentation index was derived by applying the MRI signal equation to phantom-calibrated coregistered FMX-enhanced MRI brain scans acquired before, 1-4 hours after, and 16-24 hours after FMX administration. The fraction of voxels with an FMX compartmentation index greater than 1 was computed over the whole tumor (FCIGT1) and from voxels above the 90th percentile R*2 (FCIGT1 R*2,90). Results rR*2,90 computed from pretherapy MRI performed 16-24 hours after FMX administration, without reference to calibration phantoms, predicted response to nal-IRI in thoracoabdominal metastases (accuracy, 74%). rR*2,90 performance was robust to the inclusion of some peritumoral tissue within the tumor region of interest. FCIGT1 R*2,90 provided 79% accuracy on cross-validation in prediction of response in brain metastases. Conclusion This first in-human study focused on mBC suggests that FMX-enhanced MRI biologic markers can be useful for pretherapy prediction of response to nal-IRI in patients with mBC. Keywords: MRI Contrast Agent, MRI, Breast, Head/Neck, Tumor Response, Experimental Investigations, Brain/Brain Stem Clinical trial registration no. NCT01770353 Supplemental material is available for this article. © RSNA, 2023 See also commentary by Daldrup-Link in this issue.
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Affiliation(s)
- Harshan Ravi
- From the Departments of Cancer Physiology (H.R., A.M.A.L., N.R.), Radiology (J.R.C., D.K.J.), and Breast Oncology (H.S.H.), Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612; Ipsen Bioscience, Cambridge, Mass (S.G.K.); HonorHealth Research Institute, Scottsdale, Ariz (J.C.S.); Imaging Endpoints Core Laboratory, Scottsdale, Ariz (R.L.K.); and Department of Oncologic Sciences, University of South Florida, Tampa, Fla (N.R.)
| | - Andres M Arias-Lorza
- From the Departments of Cancer Physiology (H.R., A.M.A.L., N.R.), Radiology (J.R.C., D.K.J.), and Breast Oncology (H.S.H.), Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612; Ipsen Bioscience, Cambridge, Mass (S.G.K.); HonorHealth Research Institute, Scottsdale, Ariz (J.C.S.); Imaging Endpoints Core Laboratory, Scottsdale, Ariz (R.L.K.); and Department of Oncologic Sciences, University of South Florida, Tampa, Fla (N.R.)
| | - James R Costello
- From the Departments of Cancer Physiology (H.R., A.M.A.L., N.R.), Radiology (J.R.C., D.K.J.), and Breast Oncology (H.S.H.), Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612; Ipsen Bioscience, Cambridge, Mass (S.G.K.); HonorHealth Research Institute, Scottsdale, Ariz (J.C.S.); Imaging Endpoints Core Laboratory, Scottsdale, Ariz (R.L.K.); and Department of Oncologic Sciences, University of South Florida, Tampa, Fla (N.R.)
| | - Hyo Sook Han
- From the Departments of Cancer Physiology (H.R., A.M.A.L., N.R.), Radiology (J.R.C., D.K.J.), and Breast Oncology (H.S.H.), Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612; Ipsen Bioscience, Cambridge, Mass (S.G.K.); HonorHealth Research Institute, Scottsdale, Ariz (J.C.S.); Imaging Endpoints Core Laboratory, Scottsdale, Ariz (R.L.K.); and Department of Oncologic Sciences, University of South Florida, Tampa, Fla (N.R.)
| | - Daniel K Jeong
- From the Departments of Cancer Physiology (H.R., A.M.A.L., N.R.), Radiology (J.R.C., D.K.J.), and Breast Oncology (H.S.H.), Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612; Ipsen Bioscience, Cambridge, Mass (S.G.K.); HonorHealth Research Institute, Scottsdale, Ariz (J.C.S.); Imaging Endpoints Core Laboratory, Scottsdale, Ariz (R.L.K.); and Department of Oncologic Sciences, University of South Florida, Tampa, Fla (N.R.)
| | - Stephan G Klinz
- From the Departments of Cancer Physiology (H.R., A.M.A.L., N.R.), Radiology (J.R.C., D.K.J.), and Breast Oncology (H.S.H.), Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612; Ipsen Bioscience, Cambridge, Mass (S.G.K.); HonorHealth Research Institute, Scottsdale, Ariz (J.C.S.); Imaging Endpoints Core Laboratory, Scottsdale, Ariz (R.L.K.); and Department of Oncologic Sciences, University of South Florida, Tampa, Fla (N.R.)
| | - Jasgit C Sachdev
- From the Departments of Cancer Physiology (H.R., A.M.A.L., N.R.), Radiology (J.R.C., D.K.J.), and Breast Oncology (H.S.H.), Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612; Ipsen Bioscience, Cambridge, Mass (S.G.K.); HonorHealth Research Institute, Scottsdale, Ariz (J.C.S.); Imaging Endpoints Core Laboratory, Scottsdale, Ariz (R.L.K.); and Department of Oncologic Sciences, University of South Florida, Tampa, Fla (N.R.)
| | - Ronald L Korn
- From the Departments of Cancer Physiology (H.R., A.M.A.L., N.R.), Radiology (J.R.C., D.K.J.), and Breast Oncology (H.S.H.), Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612; Ipsen Bioscience, Cambridge, Mass (S.G.K.); HonorHealth Research Institute, Scottsdale, Ariz (J.C.S.); Imaging Endpoints Core Laboratory, Scottsdale, Ariz (R.L.K.); and Department of Oncologic Sciences, University of South Florida, Tampa, Fla (N.R.)
| | - Natarajan Raghunand
- From the Departments of Cancer Physiology (H.R., A.M.A.L., N.R.), Radiology (J.R.C., D.K.J.), and Breast Oncology (H.S.H.), Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33612; Ipsen Bioscience, Cambridge, Mass (S.G.K.); HonorHealth Research Institute, Scottsdale, Ariz (J.C.S.); Imaging Endpoints Core Laboratory, Scottsdale, Ariz (R.L.K.); and Department of Oncologic Sciences, University of South Florida, Tampa, Fla (N.R.)
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Pandey S, Kutuk T, Mills M, Abdalah M, Stringfield O, Latifi K, Moreno W, Ahmed K, Raghunand N. NIMG-01. PREDICTING POST-STEREOTACTIC RADIOTHERAPY MAGNETIC RESONANCE IMAGE OUTCOMES OF BREAST CANCER METASTASES TO THE BRAIN. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.621] [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: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Stereotactic radiosurgery (SRS) is a cornerstone in the management of Breast Cancer Metastases to the Brain (BCMB). While control rates are high following SRS, radiation necrosis is a rare but potentially devastating long-term toxicity. There is a clinical need for automated/semi-automated methods to assess tumor response and optimize the RT plans for local control with minimal long-term toxicity. Multiparametric MRI (mpMRI), particularly Apparent Diffusion Coefficient of water (ADC) maps, contain information that is mechanistically relatable to voxel-level tumor response to RT. We report a deep learning-based approach to predict post-SRS ADC maps, FLAIR, T2-weighted (T2W), T1-weighted unenhanced (T1W) and contrast-enhanced (T1WCE) images, from pre-SRS T1W, T1WCE, T2W and FLAIR images, ADC maps, and the delivered RT dose map. These “forward models” will enable the radiation oncologist to simulate radiologic outcomes and iteratively optimize RT plans for local control with minimal toxicity.
METHODS
We trained a variant of the pix2pix Generative Adversarial Network (GAN) on MRI and RT dose map data from 18 BCMB patients treated with stereotactic radiation with confirmed controlled and locally recurrent metastases. Patients were treated with stereotactic radiation dose of 1-40 Gy between 2013-2019.
RESULTS
On test data from 6 BCMB patients, the trained forward model predicted post-SRS ADC values within the Gross Tumor Volume (GTV) that were broadly in agreement with ground truth post-SRS ADC maps. In agreement with expectations, the forward model also predicts increasing post-RT ADC within the GTV with increasing simulated RT doses in the range of 1-71 Gy. We have also explored an inverse model to predict the RT dose map required to produce “prescribed” post-SRS ADC values within the GTV.
CONCLUSIONS
We envision that the forward models will assist the radiation oncologist in initial RT dose plan optimization, while the inverse model may be useful for daily RT plan optimization.
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Affiliation(s)
| | - Tugce Kutuk
- Miami Cancer Institute, Baptist Health South Florida , Miami, FL , USA
| | - Matthew Mills
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | - Mahmoud Abdalah
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | - Olya Stringfield
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | - Kujtim Latifi
- H. Lee Moffitt Cancer Center & Research Institute , Tampa, FL , USA
| | | | - Kamran Ahmed
- H. Lee Moffitt Cancer Center & Research Institute , Tampa , USA
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Colin-Leitzinger C, Jeong D, Abdalah M, Cannioto R, Chern JY, Davis E, Gillies R, McGettigan M, Perez-Morales J, Raghunand N, Sinha S, Stringfield O, Tirbene R, Schabath M, Peres LC. Abstract 5886: Pre-treatment adiposity measured by computed tomography and survival of women with high-grade serous ovarian cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5886] [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: 11/16/2022]
Abstract
Abstract
The association of body mass index (BMI) with survival of women with ovarian cancer remains unclear due to mixed epidemiological evidence. This may be due, in part, to the fact that BMI is an imperfect measure of body fat as BMI does not distinguish weight from lean muscle versus adipose tissue. Here, we investigated the association of adiposity measured by computed tomography (CT) with survival among the most common histotype of ovarian cancer, high-grade serous ovarian cancer (HGSOC). The present study included 383 women diagnosed with HGSOC from 2008 to 2019 who were evaluated at H. Lee Moffitt Cancer Center and Research Institute and had pre-treatment computed tomography scans available for analysis. The sliceOmatic v5.0 rev13 (Tomovision, Magog, Canada) medical image analysis software and accompanying ABACS module for segmentation was used to quantify subcutaneous (SAT), visceral (VAT), and intermuscular adipose tissue (IMAT) from the third lumbar (L3) axial slice including the transverse processes. We used Cox proportional hazard regression to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for the association of each measure of adiposity with overall survival (OS) and recurrence-free survival (RFS) while adjusting for age at diagnosis, stage, race and ethnicity, and first-line treatment. The degree of ascites was included in the VAT models as ascites fluid density can mask VAT. We also assessed these associations within first-line treatment groups (upfront chemotherapy [n=147], upfront surgery [n=236]). In the overall study population, we observed a positive but not statistically significant association with OS and RFS for the highest vs. lowest tertile of IMAT (HR= 1.18, 95% CI=0.83, 1.67 and HR=1.16, 95% CI=0.85, 1.58, respectively). Among women who received upfront surgery, the highest tertile of IMAT was associated with a 57% increased risk of recurrence compared to the lowest tertile (HR=1.57, 95% CI=1.04, 2.37), while the association between IMAT and OS was similar to the findings in the overall population (HR=1.14, 95% CI=0.73, 1.78). No association was observed between IMAT and OS or RFS among women who received upfront chemotherapy. No associations with OS or RFS were observed for SAT or VAT overall or within first-line treatment groups. In summary, we observed inferior RFS among HGSOC patients with higher IMAT. These findings suggest that IMAT measured from standard-of-care imaging may represent a biomarker of recurrence among HGSOC patients, and incorporating lifestyle and behavioral changes (e.g., diet, exercise) to decrease IMAT may be warranted for this patient population.
Citation Format: Christelle Colin-Leitzinger, Daniel Jeong, Mahmoud Abdalah, Rikki Cannioto, Jing-Yi Chern, Evan Davis, Robert Gillies, Melissa McGettigan, Jaileene Perez-Morales, Natarajan Raghunand, Sweta Sinha, Olya Stringfield, Rajwantee Tirbene, Matthew Schabath, Lauren C. Peres. Pre-treatment adiposity measured by computed tomography and survival of women with high-grade serous ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5886.
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Affiliation(s)
| | - Daniel Jeong
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Mahmoud Abdalah
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Jing-Yi Chern
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Evan Davis
- 2Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Robert Gillies
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Sweta Sinha
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | | | - Lauren C. Peres
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Perez-Morales J, Leitzinger CMC, Sinha SK, McGettigan MJ, Jeong DK, Stringfield O, Abdala M, Raghunand N, Gillies RJ, Chern JY, Peres LC, Schabath MB. Abstract 3218: Radiomic biomarkers to optimize treatment decision and predict patient outcomes in serous ovarian carcinoma. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3218] [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: 11/16/2022]
Abstract
Abstract
Background: There are two first-line treatment recommendations for advanced ovarian cancer: i) upfront cytoreductive debulking followed by chemotherapy and ii) neoadjuvant chemotherapy prior to surgical debulking. The choice between these two treatment strategies is controversial as there are no standardized guidelines for clinical decision support. As such, there remains a critical unmet need to identity biomarkers to personalize the most effective treatment strategies. The primary objective of this study is to identify and validate radiomic biomarkers that predict treatment response among patients with high-grade serous ovarian cancer treated with upfront surgical debulking.
Methods: Intratumoral radiomic features (n=308) were extracted from pre-treatment contrast-enhanced CT images; analyses were conducted to remove correlated, non-stable, and non-reproducible features. Patients treated with upfront surgery (N=182) were split into training (N=91) and test (N=91) cohorts and a cohort of patients treated with upfront neoadjuvant (N=116) was used to determine if the radiomic features were prognostic or predictive. Overall (OS) and progression-free survival (PFS) were the main endpoints. Classification and Regression Tree analysis was used to identity the most informative radiomic features in the training cohort, which were then analyzed in the test cohort and the upfront neoadjuvant cohort.
Results: Decision tree analysis identified a volumetric feature, ROI volume center of mass (CoM) in X direction, as the most informative radiomic feature which stratified upfront surgery patients into high- and low-risk. In the training cohort, high-risk patients were associated with significantly worse OS versus low-risk patients (HR=2.01; 95% CI 1.07-3.77 vs. 1.00 and 5-year OS=39.9% vs. 56.1%, respectively; log-rank p-value=0.03). In the test cohort, the high- vs. low-risk patients were also associated with poor OS (HR=2.23; 95% CI 1.19-4.17 vs. 1.00 and 5-year OS=23.3% vs. 51.3%, respectively; log-rank p-value=0.01). This radiomic feature was not associated with OS among patients with upfront neoadjuvant (HR=1.23; 95% CI 0.73-2.07 vs. 1.00 and 5-year OS=23.9% vs. 36.6%, respectively; log-rank p-value=0.44). Similar findings were observed for PFS.
Conclusion: Utilizing standard-of-care imaging, we identified and validated a predictive radiomic feature associated with outcomes among patients with high-grade serous ovarian cancer treated with upfront surgical debulking but not among patients treated with neoadjuvant chemotherapy. This radiomic biomarker, which describes the location of center of mass inside the tumor in pixels in the x-direction, could be potentially utilized as clinical decision support to guide first-line treatment options. This study was generously funded by a Miles for Moffitt pilot grant.
Citation Format: Jaileene Perez-Morales, Christelle M. Colin Leitzinger, Sweta K. Sinha, Melissa J. McGettigan, Daniel K. Jeong, Olya Stringfield, Mahmoud Abdala, Natarajan Raghunand, Robert J. Gillies, Jing-Yi Chern, Lauren C. Peres, Matthew B. Schabath. Radiomic biomarkers to optimize treatment decision and predict patient outcomes in serous ovarian carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3218.
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Affiliation(s)
| | | | - Sweta K. Sinha
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Daniel K. Jeong
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Mahmoud Abdala
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - Jing-Yi Chern
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Lauren C. Peres
- 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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8
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Weinfurtner RJ, Abdalah M, Stringfield O, Ataya D, Williams A, Mooney B, Rosa M, Lee MC, Khakpour N, Laronga C, Czerniecki B, Diaz R, Ahmed K, Washington I, Latifi K, Niell BL, Montejo M, Raghunand N. Quantitative Changes in Intratumoral Habitats on MRI Correlate With Pathologic Response in Early-stage ER/PR+ HER2- Breast Cancer Treated With Preoperative Stereotactic Ablative Body Radiotherapy. J Breast Imaging 2022; 4:273-284. [PMID: 36686407 PMCID: PMC9851176 DOI: 10.1093/jbi/wbac013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 02/01/2023]
Abstract
Objective To quantitatively evaluate intratumoral habitats on dynamic contrast-enhanced (DCE) breast MRI to predict pathologic breast cancer response to stereotactic ablative body radiotherapy (SABR). Methods Participants underwent SABR treatment (28.5 Gy x3), baseline and post-SABR MRI, and breast-conserving surgery for ER/PR+ HER2- breast cancer. MRI analysis was performed on DCE T1-weighted images. MRI voxels were assigned eight habitats based on high (H) or low (L) maximum enhancement and the sequentially numbered dynamic sequence of maximum enhancement (H1-4, L1-4). MRI response was analyzed by percent tumor volume remaining (%VR = volume post-SABR/volume pre-SABR), and percent habitat makeup (%HM of habitat X = habitat X voxels/total voxels in the segmented volume). These were correlated with percent tumor bed cellularity (%TC) for pathologic response. Results Sixteen patients completed the trial. The %TC ranged 20%-80%. MRI %VR demonstrated strong correlations with %TC (Pearson R = 0.7-0.89). Pre-SABR tumor %HMs differed significantly from whole breasts (P = 0.005 to <0.00001). Post-SABR %HM of tumor habitat H4 demonstrated the largest change, increasing 13% (P = 0.039). Conversely, combined %HM for H1-3 decreased 17% (P = 0.006). This change correlated with %TC (P < 0.00001) and distinguished pathologic partial responders (≤70 %TC) from nonresponders with 94% accuracy, 93% sensitivity, 100% specificity, 100% positive predictive value, and 67% negative predictive value. Conclusion In patients undergoing preoperative SABR treatment for ER/PR+ HER2- breast cancer, quantitative MRI habitat analysis of %VR and %HM change correlates with pathologic response.
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Affiliation(s)
| | - Mahmoud Abdalah
- Moffitt Cancer Center, Quantitative Imaging Core, Tampa, Fl, USA
| | - Olya Stringfield
- Moffitt Cancer Center, Quantitative Imaging Core, Tampa, Fl, USA
| | - Dana Ataya
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Angela Williams
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Blaise Mooney
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Marilin Rosa
- Moffitt Cancer Center, Department of Pathology, Tampa, FL, USA
| | - Marie C Lee
- Moffitt Cancer Center, Department of Surgery, Tampa, FL, USA
| | | | | | | | - Roberto Diaz
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Kamran Ahmed
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Iman Washington
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Kujtim Latifi
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Bethany L Niell
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Michael Montejo
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
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Youssef I, Poch M, Raghunand N, Pow-Sang J, Johnstone PAS. Analysis of MRI radiomic pelvimetry and correlation with margin status after robotic prostatectomy. Can J Urol 2022; 29:10976-10978. [PMID: 35150217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION To evaluate the use of preoperative magnetic resonance imaging (MRI) as a predictor of positive margins after radical prostatectomy (RP). This is important as such patients may benefit from postoperative radiotherapy. With the advent of preoperative MRI, we posited that pelvimetry could predict positive margins after RP in patients with less-than ideal pelvic dimensions undergoing robotic-assisted laparoscopic surgery. MATERIALS AND METHODS After IRB approval, data from patients undergoing RP at our center between 1/1/2018 and 12/31/2019 (n = 314) who had undergone prior prostate MRI imaging (n = 102) were analyzed. All RPs were performed using robotic-assisted laparoscopic technique. Data from the cancer center data warehouse were retrieved, to include postoperative T-stage, gland size, responsible surgeon, PSA, patient body mass index, and surgical margin status. These data were analyzed with corresponding pelvimetry data from 91 preoperative scans with complete data and imaging. RESULTS On multivariable analysis, pathologic T-stage (p = 0.004), anteroposterior pelvic outlet (p = 0.015) and pelvic depth (length of the pubic symphysis; p = 0.019) were all statistically correlated with positive surgical margins. CONCLUSIONS With the widespread use of MRI in the initial staging of prostate cancer, automated radiomic analysis could augment the critical data already being accumulated in terms of seminal vesical involvement, extracapsular extension, and suspicious lymph nodes as risk factors for postoperative salvage radiation. Such automated data could help screen patients preoperatively for robotic RP.
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Affiliation(s)
- Irini Youssef
- SUNY Downstate Medical Center, Brooklyn, New York, USA
- Maimonides Cancer Center, Brooklyn, New York, USA
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10
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Pandey S, Snider AD, Moreno WA, Ravi H, Bilgin A, Raghunand N. Joint total variation-based reconstruction of multiparametric magnetic resonance images for mapping tissue types. NMR Biomed 2021; 34:e4597. [PMID: 34390047 DOI: 10.1002/nbm.4597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
Multispectral analysis of coregistered multiparametric magnetic resonance (MR) images provides a powerful method for tissue phenotyping and segmentation. Acquisition of a sufficiently varied set of multicontrast MR images and parameter maps to objectively define multiple normal and pathologic tissue types can require long scan times. Accelerated MRI on clinical scanners with multichannel receivers exploits techniques such as parallel imaging, while accelerated preclinical MRI scanning must rely on alternate approaches. In this work, tumor-bearing mice were imaged at 7 T to acquire k-space data corresponding to a series of images with varying T1-, T2- and T2*-weighting. A joint reconstruction framework is proposed to reconstruct a series of T1-weighted images and corresponding T1 maps simultaneously from undersampled Cartesian k-space data. The ambiguity introduced by undersampling was resolved by using model-based constraints and structural information from a reference fully sampled image as the joint total variation prior. This process was repeated to reconstruct T2-weighted and T2*-weighted images and corresponding maps of T2 and T2* from undersampled Cartesian k-space data. Validation of the reconstructed images and parameter maps was carried out by computing tissue-type maps, as well as maps of the proton density fat fraction (PDFF), proton density water fraction (PDwF), fat relaxation rate ( R2f*) and water relaxation rate ( R2w*) from the reconstructed data, and comparing them with ground truth (GT) equivalents. Tissue-type maps computed using 18% k-space data were visually similar to GT tissue-type maps, with dice coefficients ranging from 0.43 to 0.73 for tumor, fluid adipose and muscle tissue types. The mean T1 and T2 values within each tissue type computed using only 18% k-space data were within 8%-10% of the GT values from fully sampled data. The PDFF and PDwF maps computed using 27% k-space data were within 3%-15% of GT values and showed good agreement with the expected values for the four tissue types.
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Affiliation(s)
- Shraddha Pandey
- Department of Cancer Physiology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Electrical Engineering, University of South Florida, Tampa, Florida, USA
| | - A David Snider
- Department of Electrical Engineering, University of South Florida, Tampa, Florida, USA
| | - Wilfrido A Moreno
- Department of Electrical Engineering, University of South Florida, Tampa, Florida, USA
| | - Harshan Ravi
- Department of Cancer Physiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Ali Bilgin
- Departments of Medical Imaging, Biomedical Engineering, and Electrical and Computer Engineering, University of Arizona, Tucson, Arizona, USA
| | - Natarajan Raghunand
- Department of Cancer Physiology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, Florida, USA
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11
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Kutuk T, Pandey S, Mills M, Abdalah M, Stringfield O, Latifi K, Robinson T, Ahmed K, Raghunand N. Utilizing Radiation Dose Maps to Predict Local Failure Following Stereotactic Radiation of Brain Metastases. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1540] [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: 11/15/2022]
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McDonald J, Raghunand N, Rejniak K, Frakes J, Song E, Latifi K, Kim D, Carballido E, Denbo J, Pimiento J, Parsee A, Hodul P, Hoffe S, Costello J. Multisequence MRI With Functional Imaging May Improve Pseudoprogression vs. Viable Tumor Determination Following High Dose Adaptive MRgRT in Patients With Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Weinfurtner RJ, Raghunand N, Stringfield O, Abdalah M, Niell BL, Ataya D, Williams A, Mooney B, Rosa M, Lee MC, Khakpour N, Laronga C, Czerniecki B, Diaz R, Ahmed K, Washington I, Montejo M. MRI Response to Pre-operative Stereotactic Ablative Body Radiotherapy (SABR) in Early Stage ER/PR+ HER2- Breast Cancer correlates with Surgical Pathology Tumor Bed Cellularity. Clin Breast Cancer 2021; 22:e214-e223. [PMID: 34384695 DOI: 10.1016/j.clbc.2021.06.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/29/2021] [Accepted: 06/28/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study evaluates breast MRI response of ER/PR+ HER2- breast tumors to pre-operative SABR with pathologic response correlation. METHODS Women enrolled in a phase 2 single institution trial of SABR for ER/PR+ HER2- breast cancer were retrospectively evaluated for radiologic-pathologic correlation of tumor response. These patients underwent baseline breast MRI, SABR (28.5 Gy in 3 fractions), follow-up MRI 5 to 6 weeks post-SABR, and lumpectomy. Tumor size and BI-RADS descriptors on pre and post-SABR breast MRIs were compared to determine correlation with surgical specimen % tumor cellularity (%TC). Reported MRI tumor dimensions were used to calculate percent cubic volume remaining (%VR). Partial MRI response was defined as a BI-RADs descriptor change or %VR ≤ 70%, while partial pathologic response (pPR) was defined as %TC ≤ 70%. RESULTS Nineteen patients completed the trial, and %TC ranged 10% to 80%. For BI-RADS descriptor analysis, 12 of 19 (63%) showed change in lesion or kinetic enhancement descriptors post-SABR. This was associated with lower %TC (29% vs. 47%, P = .042). BI-RADS descriptor change analysis also demonstrated high PPV (100%) and specificity (100%) for predicting pPR to treatment (sensitivity 71%, accuracy 74%), but low NPV (29%). MRI %VR demonstrated strong linear correlation with %TC (R = 0.70, P < .001, Pearson's Correlation) and high accuracy (89%) for predicting pPR (sensitivity 88%, specificity 100%, PPV 100%, and NPV 50%). CONCLUSION Evaluating breast cancer response on MRI using %VR after pre-operative SABR treatment can help identify patients benefiting the most from neoadjuvant radiation treatment of their ER/PR+ HER2- tumors, a group in which pCR to neoadjuvant therapy is rare.
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Affiliation(s)
| | | | - Olya Stringfield
- Post-doctoral Fellow, Quantitative Imaging Core, Moffitt Cancer Center, Tampa, FL
| | - Mahmoud Abdalah
- Post-doctoral Fellow, Quantitative Imaging Core, Moffitt Cancer Center, Tampa, FL
| | - Bethany L Niell
- Associate Member of Radiology, Moffitt Cancer Center, Tampa, FL
| | - Dana Ataya
- Assistant Member of Radiology, Moffitt Cancer Center, Tampa, FL
| | - Angela Williams
- Assistant Member of Radiology, Moffitt Cancer Center, Tampa, FL
| | - Blaise Mooney
- Assosciate Member of Radiology, Moffitt Cancer Center, Tampa, FL
| | - Marilin Rosa
- Associate Member of Pathology, Moffitt Cancer Center, Tampa, FL
| | - Marie C Lee
- Associate Member of Breast Surgery, Moffitt Cancer Center, Tampa, FL
| | - Nazanin Khakpour
- Senior Member of Breast Surgery, Moffitt Cancer Center, Tampa, FL
| | - Christine Laronga
- Associate Member of Breast Surgery, Moffitt Cancer Center, Tampa, FL
| | - Brian Czerniecki
- Associate Member of Breast Surgery, Moffitt Cancer Center, Tampa, FL
| | - Roberto Diaz
- Senior Member of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Kamran Ahmed
- Assistant Member of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Iman Washington
- Assistant Member of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Michael Montejo
- Assistant Member of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
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14
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Sahebjam S, Forsyth PA, Tran ND, Arrington JA, Macaulay R, Etame AB, Walko CM, Boyle T, Peguero EN, Jaglal M, Mokhtari S, Enderling H, Raghunand N, Gatewood T, Long W, Dzierzeski JL, Evernden B, Robinson T, Wicklund MC, Kim S, Thompson ZJ, Chen DT, Chinnaiyan P, Yu HHM. Hypofractionated stereotactic re-irradiation with pembrolizumab and bevacizumab in patients with recurrent high-grade gliomas: results from a phase I study. Neuro Oncol 2021; 23:677-686. [PMID: 33173935 DOI: 10.1093/neuonc/noaa260] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Radiotherapy may synergize with programmed cell death 1 (PD1)/PD1 ligand (PD-L1) blockade. The purpose of this study was to determine the recommended phase II dose, safety/tolerability, and preliminary efficacy of combining pembrolizumab, an anti-PD1 monoclonal antibody, with hypofractionated stereotactic irradiation (HFSRT) and bevacizumab in patients with recurrent high-grade gliomas (HGGs). METHODS Eligible subjects with recurrent glioblastoma or anaplastic astrocytoma were treated with pembrolizumab (100 or 200 mg based on dose level Q3W) concurrently with HFSRT (30 Gy in 5 fractions) and bevacizumab 10 mg/kg Q2W. RESULTS Thirty-two patients were enrolled (bevacizumab-naïve, n = 24; bevacizumab-resistant, n = 8). The most common treatment-related adverse events (TRAEs) were proteinuria (40.6%), fatigue (25%), increased alanine aminotransferase (25%), and hypertension (25%). TRAEs leading to discontinuation occurred in 1 patient who experienced a grade 3 elevation of aspartate aminotransferase. In the bevacizumab-naïve cohort, 20 patients (83%) had a complete response or partial response. The median overall survival (OS) and progression-free survival (PFS) were 13.45 months (95% CI: 9.46-18.46) and 7.92 months (95% CI: 6.31-12.45), respectively. In the bevacizumab-resistant cohort, PR was achieved in 5 patients (62%). Median OS was 9.3 months (95% CI: 8.97-18.86) with a median PFS of 6.54 months (95% CI: 5.95-18.86). The majority of patients (n = 20/26; 77%) had tumor-cell/tumor-microenvironment PD-L1 expression <1%. CONCLUSIONS The combination of HFSRT with pembrolizumab and bevacizumab in patients with recurrent HGG is generally safe and well tolerated. These findings merit further investigation of HFSRT with immunotherapy in HGGs.
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Affiliation(s)
- Solmaz Sahebjam
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Peter A Forsyth
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Nam D Tran
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - John A Arrington
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Robert Macaulay
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Arnold B Etame
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Christine M Walko
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Theresa Boyle
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Edwin N Peguero
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Michael Jaglal
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Sepideh Mokhtari
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Heiko Enderling
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Natarajan Raghunand
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Tyra Gatewood
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Wendy Long
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | | | - Timothy Robinson
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | | | - Sungjune Kim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | | | - Dung-Tsa Chen
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Prakash Chinnaiyan
- Beaumont Health and Oakland University School of Medicine, Royal Oak, Michigan, USA
| | - Hsiang-Hsuan Michael Yu
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
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15
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Mazin A, Hawkins SH, Stringfield O, Dhillon J, Manley BJ, Jeong DK, Raghunand N. Identification of sarcomatoid differentiation in renal cell carcinoma by machine learning on multiparametric MRI. Sci Rep 2021; 11:3785. [PMID: 33589715 PMCID: PMC7884398 DOI: 10.1038/s41598-021-83271-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/15/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Sarcomatoid differentiation in RCC (sRCC) is associated with a poor prognosis, necessitating more aggressive management than RCC without sarcomatoid components (nsRCC). Since suspected renal cell carcinoma (RCC) tumors are not routinely biopsied for histologic evaluation, there is a clinical need for a non-invasive method to detect sarcomatoid differentiation pre-operatively. We utilized unsupervised self-organizing map (SOM) and supervised Learning Vector Quantizer (LVQ) machine learning to classify RCC tumors on T2-weighted, non-contrast T1-weighted fat-saturated, contrast-enhanced arterial-phase T1-weighted fat-saturated, and contrast-enhanced venous-phase T1-weighted fat-saturated MRI images. The SOM was trained on 8 nsRCC and 8 sRCC tumors, and used to compute Activation Maps for each training, validation (3 nsRCC and 3 sRCC), and test (5 nsRCC and 5 sRCC) tumor. The LVQ classifier was trained and optimized on Activation Maps from the 22 training and validation cohort tumors, and tested on Activation Maps of the 10 unseen test tumors. In this preliminary study, the SOM-LVQ model achieved a hold-out testing accuracy of 70% in the task of identifying sarcomatoid differentiation in RCC on standard multiparameter MRI (mpMRI) images. We have demonstrated a combined SOM-LVQ machine learning approach that is suitable for analysis of limited mpMRI datasets for the task of differential diagnosis.
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Affiliation(s)
- Asim Mazin
- Department of Cancer Physiology, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Samuel H Hawkins
- Department of Cancer Physiology, Moffitt Cancer Center, Tampa, FL, 33612, USA
- Department of Computer Science & Information Systems, Bradley University, Peoria, IL, 61625, USA
| | - Olya Stringfield
- IRAT Shared Service, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Jasreman Dhillon
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, 33612, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Brandon J Manley
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, 33612, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Daniel K Jeong
- Department of Diagnostic & Interventional Radiology, Moffitt Cancer Center, Tampa, FL, 33612, USA
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Natarajan Raghunand
- Department of Cancer Physiology, Moffitt Cancer Center, Tampa, FL, 33612, USA.
- Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
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16
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Hernandez-Prera JC, Valderrabano P, Creed JH, de la Iglesia JV, Slebos RJ, Centeno BA, Tarasova V, Hallanger-Johnson J, Veloski C, Otto KJ, Wenig BM, Yoder SJ, Lam CA, Park DS, Anderson AR, Raghunand N, Berglund A, Caudell J, Gerke TA, Chung CH. Molecular Determinants of Thyroid Nodules with Indeterminate Cytology and RAS Mutations. Thyroid 2021; 31:36-49. [PMID: 32689909 PMCID: PMC7864115 DOI: 10.1089/thy.2019.0650] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background:RAS gene family mutations are the most prevalent in thyroid nodules with indeterminate cytology and are present in a wide spectrum of histological diagnoses. We evaluated differentially expressed genes and signaling pathways across the histological/clinical spectrum of RAS-mutant nodules to determine key molecular determinants associated with a high risk of malignancy. Methods: Sixty-one thyroid nodules with RAS mutations were identified. Based on the histological diagnosis and biological behavior, the nodules were grouped into five categories indicating their degree of malignancy: non-neoplastic appearance, benign neoplasm, indeterminate malignant potential, low-risk cancer, or high-risk cancer. Gene expression profiles of these nodules were determined using the NanoString PanCancer Pathways and IO 360 Panels, and Angiopoietin-2 level was determined by immunohistochemical staining. Results: The analysis of differentially expressed genes using the five categories as supervising parameters unearthed a significant correlation between the degree of malignancy and genes involved in cell cycle and apoptosis (BAX, CCNE2, CDKN2A, CDKN2B, CHEK1, E2F1, GSK3B, NFKB1, and PRKAR2A), PI3K pathway (CCNE2, CSF3, GSKB3, NFKB1, PPP2R2C, and SGK2), and stromal factors (ANGPT2 and DLL4). The expression of Angiopoietin-2 by immunohistochemistry also showed the same trend of increasing expression from non-neoplastic appearance to high-risk cancer (p < 0.0001). Conclusions: The gene expression analysis of RAS-mutant thyroid nodules suggests increasing upregulation of key oncogenic pathways depending on their degree of malignancy and supports the concept of a stepwise progression. The utility of ANGPT2 expression as a potential diagnostic biomarker warrants further evaluation.
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Affiliation(s)
- Juan C. Hernandez-Prera
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
- Juan C. Hernandez-Prera, MD, Department of Pathology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Pablo Valderrabano
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Jordan H. Creed
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Janis V. de la Iglesia
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Robbert J.C. Slebos
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Valentina Tarasova
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Colleen Veloski
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Kristen J. Otto
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Bruce M. Wenig
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Sean J. Yoder
- Molecular Genomics Core Facility, Moffitt Cancer Center, Tampa, Florida, USA
| | - Cesar A. Lam
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Derek S. Park
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Alexander R. Anderson
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Anders Berglund
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jimmy Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Travis A. Gerke
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Christine H. Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Address correspondence to: Christine H. Chung, MD, Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
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Aarntzen E, Achilefu S, Akam EA, Albaghdadi M, Beer AJ, Bharti S, Bhujwalla ZM, Bischof GN, Biswal S, Boss M, Botnar RM, Brinson Z, Brom M, Buitinga M, Bulte JW, Caravan P, Chan HP, Chandy M, Chaney AM, Chen DL, Chen X(S, Chenevert TL, Coughlin JM, Covington MF, Cumming P, Daldrup-Link HE, Deal EM, de Galan B, Derlin T, Dewhirst MW, Di Paolo A, Drzezga A, Du Y, Thi-Quynh Duong M, Ehman RL, Eriksson O, Galli F, Gatenby RA, Gelovani J, Giehl K, Giger ML, Goel R, Gold G, Gotthardt M, Graham MM, Gropler RJ, Gründer G, Gulhane A, Hadjiiski L, Hajhosseiny R, Hammoud DA, Helfer BM, Hicks RJ, Higuchi T, Hoffman JM, Honer M, Huang SC(H, Hung J, Hwang DW, Jackson IM, Jacobs AH, Jaffer FA, Jain SK, James ML, Jansen T, Johansson L, Joosten L, Kakkad S, Kamson D, Kang SR, Kelly KA, Knopp MI, Knopp MV, Kogan F, Krishnamachary B, Künnecke B, Lee DS, Libby P, Luker GD, Luker KE, Makowski MR, Mankoff DA, Massoud TF, Meyer CR, Miller Z, Min JJ, Mondal SB, Montesi SB, Navin PJ, Nekolla SG, Niu G, Notohamiprodjo S, Ordoñez AA, Osborn EA, Pacheco-Torres J, Pagano G, Palmer GM, Paulmurugan R, Penet MF, Phinikaridou A, Pomper MG, Prieto C, Qi H, Raghunand N, Ramar T, Reynolds F, Ropella-Panagis K, Ross BD, Rowe SP, Rudin M, Sadaghiani MS, Sager H, Samala R, Saraste A, Schelhaas S, Schwaiger M, Schwarz SW, Seiberlich N, Shapiro MG, Shim H, Signore A, Solnes LB, Suh M, Tsien C, van Eimeren T, Varasteh Z, Venkatesh SK, Viel T, Waerzeggers Y, Wahl RL, Weber W, Werner RA, Winkeler A, Wong DF, Wright CL, Wu AM, Wu JC, Yoon D, You SH, Yuan C, Yuan H, Zanzonico P, Zhao XQ, Zhou IY, Zinnhardt B. Contributors. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.01004-8] [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: 11/27/2022] Open
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Lorza AMA, Ravi H, Philip RC, Galons JP, Trouard TP, Parra NA, Von Hoff DD, Read WL, Tibes R, Korn RL, Raghunand N. Dose-response assessment by quantitative MRI in a phase 1 clinical study of the anti-cancer vascular disrupting agent crolibulin. Sci Rep 2020; 10:14449. [PMID: 32879326 PMCID: PMC7468301 DOI: 10.1038/s41598-020-71246-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023] Open
Abstract
The vascular disrupting agent crolibulin binds to the colchicine binding site and produces anti-vascular and apoptotic effects. In a multisite phase 1 clinical study of crolibulin (NCT00423410), we measured treatment-induced changes in tumor perfusion and water diffusivity (ADC) using dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted MRI (DW-MRI), and computed correlates of crolibulin pharmacokinetics. 11 subjects with advanced solid tumors were imaged by MRI at baseline and 2–3 days post-crolibulin (13–24 mg/m2). ADC maps were computed from DW-MRI. Pre-contrast T1 maps were computed, co-registered with the DCE-MRI series, and maps of area-under-the-gadolinium-concentration-curve-at-90 s (AUC90s) and the Extended Tofts Model parameters ktrans, ve, and vp were calculated. There was a strong correlation between higher plasma drug \documentclass[12pt]{minimal}
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\begin{document}$${C}^{max}$$\end{document}Cmax and a linear combination of (1) reduction in tumor fraction with \documentclass[12pt]{minimal}
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\begin{document}$${AUC}_{90s}>15.8$$\end{document}AUC90s>15.8 mM s, and, (2) increase in tumor fraction with \documentclass[12pt]{minimal}
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\begin{document}$${v}_{e}<0.3$$\end{document}ve<0.3. A higher plasma drug AUC was correlated with a linear combination of (1) increase in tumor fraction with \documentclass[12pt]{minimal}
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\begin{document}$${\text{ADC}} < 1.1 \times 10^{ - 3} \;{\text{mm}}^{2} /{\text{s}}$$\end{document}ADC<1.1×10-3mm2/s, and, (2) increase in tumor fraction with \documentclass[12pt]{minimal}
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\begin{document}$$v_{e}<0.3$$\end{document}ve<0.3. These findings are suggestive of cell swelling and decreased tumor perfusion 2–3 days post-treatment with crolibulin. The multivariable linear regression models reported here can inform crolibulin dosing in future clinical studies of crolibulin combined with cytotoxic or immune-oncology agents.
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Affiliation(s)
- Andres M Arias Lorza
- Department of Cancer Physiology, Moffitt Cancer Center, SRB-4, Tampa, FL, 33612, USA
| | - Harshan Ravi
- Department of Cancer Physiology, Moffitt Cancer Center, SRB-4, Tampa, FL, 33612, USA
| | - Rohit C Philip
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | | | - Theodore P Trouard
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85724, USA
| | - Nestor A Parra
- Department of Cancer Physiology, Moffitt Cancer Center, SRB-4, Tampa, FL, 33612, USA
| | - Daniel D Von Hoff
- Translational Genomics Research Institute (TGen), Phoenix, AZ, USA.,HonorHealth Clinical Research Institute, Scottsdale, AZ, USA
| | - William L Read
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Raoul Tibes
- Department of Internal Medicine II, Julius Maximilians University and Medical Center, Würzburg, Germany
| | | | - Natarajan Raghunand
- Department of Cancer Physiology, Moffitt Cancer Center, SRB-4, Tampa, FL, 33612, USA. .,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA.
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Glazar DJ, Grass GD, Arrington JA, Forsyth PA, Raghunand N, Yu HHM, Sahebjam S, Enderling H. Tumor Volume Dynamics as an Early Biomarker for Patient-Specific Evolution of Resistance and Progression in Recurrent High-Grade Glioma. J Clin Med 2020; 9:E2019. [PMID: 32605050 PMCID: PMC7409184 DOI: 10.3390/jcm9072019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 06/11/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/16/2022] Open
Abstract
Recurrent high-grade glioma (HGG) remains incurable with inevitable evolution of resistance and high inter-patient heterogeneity in time to progression (TTP). Here, we evaluate if early tumor volume response dynamics can calibrate a mathematical model to predict patient-specific resistance to develop opportunities for treatment adaptation for patients with a high risk of progression. A total of 95 T1-weighted contrast-enhanced (T1post) MRIs from 14 patients treated in a phase I clinical trial with hypo-fractionated stereotactic radiation (HFSRT; 6 Gy × 5) plus pembrolizumab (100 or 200 mg, every 3 weeks) and bevacizumab (10 mg/kg, every 2 weeks; NCT02313272) were delineated to derive longitudinal tumor volumes. We developed, calibrated, and validated a mathematical model that simulates and forecasts tumor volume dynamics with rate of resistance evolution as the single patient-specific parameter. Model prediction performance is evaluated based on how early progression is predicted and the number of false-negative predictions. The model with one patient-specific parameter describing the rate of evolution of resistance to therapy fits untrained data ( R 2 = 0.70 ). In a leave-one-out study, for the nine patients that had T1post tumor volumes ≥1 cm3, the model was able to predict progression on average two imaging cycles early, with a median of 9.3 (range: 3-39.3) weeks early (median progression-free survival was 27.4 weeks). Our results demonstrate that early tumor volume dynamics measured on T1post MRI has the potential to predict progression following the protocol therapy in select patients with recurrent HGG. Future work will include testing on an independent patient dataset and evaluation of the developed framework on T2/FLAIR-derived data.
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Affiliation(s)
- Daniel J. Glazar
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA;
| | - G. Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (G.D.G.); (H.-H.M.Y.)
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
| | - John A. Arrington
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL 33612, USA
- Department of Radiology, University of South Florida, Tampa, FL 33612, USA
| | - Peter A. Forsyth
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Natarajan Raghunand
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (G.D.G.); (H.-H.M.Y.)
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
| | - Solmaz Sahebjam
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Heiko Enderling
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA;
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (G.D.G.); (H.-H.M.Y.)
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
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Stringfield O, Arrington JA, Johnston SK, Rognin NG, Peeri NC, Balagurunathan Y, Jackson PR, Clark-Swanson KR, Swanson KR, Egan KM, Gatenby RA, Raghunand N. Multiparameter MRI Predictors of Long-Term Survival in Glioblastoma Multiforme. ACTA ACUST UNITED AC 2020; 5:135-144. [PMID: 30854451 PMCID: PMC6403044 DOI: 10.18383/j.tom.2018.00052] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Indexed: 12/11/2022]
Abstract
Standard-of-care multiparameter magnetic resonance imaging (MRI) scans of the brain were used to objectively subdivide glioblastoma multiforme (GBM) tumors into regions that correspond to variations in blood flow, interstitial edema, and cellular density. We hypothesized that the distribution of these distinct tumor ecological "habitats" at the time of presentation will impact the course of the disease. We retrospectively analyzed initial MRI scans in 2 groups of patients diagnosed with GBM, a long-term survival group comprising subjects who survived >36 month postdiagnosis, and a short-term survival group comprising subjects who survived ≤19 month postdiagnosis. The single-institution discovery cohort contained 22 subjects in each group, while the multi-institution validation cohort contained 15 subjects per group. MRI voxel intensities were calibrated, and tumor voxels clustered on contrast-enhanced T1-weighted and fluid-attenuated inversion-recovery (FLAIR) images into 6 distinct "habitats" based on low- to medium- to high-contrast enhancement and low-high signal on FLAIR scans. Habitat 6 (high signal on calibrated contrast-enhanced T1-weighted and FLAIR sequences) comprised a significantly higher volume fraction of tumors in the long-term survival group (discovery cohort, 35% ± 6.5%; validation cohort, 34% ± 4.8%) compared with tumors in the short-term survival group (discovery cohort, 17% ± 4.5%, P < .03; validation cohort, 16 ± 4.0%, P < .007). Of the 6 distinct MRI-defined habitats, the fractional tumor volume of habitat 6 at diagnosis was significantly predictive of long- or short-term survival. We discuss a possible mechanistic basis for this association and implications for habitat-driven adaptive therapy of GBM.
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Affiliation(s)
| | - John A Arrington
- Departments of Diagnostic & Interventional Radiology.,Department of Oncologic Sciences, University of S Florida, Tampa, FL
| | - Sandra K Johnston
- Mathematical NeuroOncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ.,Department of Radiology, University of Washington, Seattle, WA; and
| | | | - Noah C Peeri
- Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL
| | | | - Pamela R Jackson
- Mathematical NeuroOncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Kamala R Clark-Swanson
- Mathematical NeuroOncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Kristin R Swanson
- Mathematical NeuroOncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Kathleen M Egan
- Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL.,Department of Oncologic Sciences, University of S Florida, Tampa, FL
| | - Robert A Gatenby
- Departments of Diagnostic & Interventional Radiology.,Department of Oncologic Sciences, University of S Florida, Tampa, FL
| | - Natarajan Raghunand
- Cancer Physiology, and.,Department of Oncologic Sciences, University of S Florida, Tampa, FL
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Glazar D, Brady R, Howard R, Grass D, Arrington J, Yu M, Raghunand N, Sahebjam S, Enderling H. COMP-13. EARLY TUMOR VOLUME EVOLUTION ADAPTIVELY PREDICTS PATIENT-SPECIFIC RESPONSE AND PROGRESSION RISK TO RADIOTHERAPY, PEMBROLIZUMAB, AND BEVACIZUMAB IN RECURRENT HIGH-GRADE GLIOMA IN A PHASE I TRIAL. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.256] [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: 11/13/2022] Open
Abstract
Abstract
PURPOSE/OBJECTIVES
We set out to predict response and progression risk in recurrent high-grade glioma patients treated with hypofractionated stereotactic radiation plus pembrolizumab and bevacizumab (NCT02313272). At present RANO criteria define progression as 25% increase in sum of the products of perpendicular diameters of enhancing lesions compared with the smallest tumor measurement (either at baseline or best response) or significant increase in T2/FLAIR non-enhancing lesion on stable or increasing doses of corticosteroids. To this extent, a predictive model is needed to adaptively learn and forecast individual response to therapy. We evaluate if early tumor volume evolution can train a mathematical model to predict subsequent response to therapy.
MATERIALS/METHODS
We develop a mathematical model that describes patient-uniform tumor growth rate and initial pembrolizumab and bevacizumab responses, and patient-specific treatment response dynamics. A total of 154 radiology scans were delineated to derive longitudinal tumor volumes of 26 patients. In a leave-one-out study, patient-uniform model parameters are derived and then applied to the left-out patient to adaptively learn treatment response dynamics to forecast tumor volume evolution and progression risk. Model prediction performance is evaluated based on classification accuracy, including sensitivity and specificity.
RESULTS
Patient-uniform glioma growth rate and initial treatment response rates are estimated to achieve acceptable fits to the longitudinal data of all untrained patients with R2 = 0.81 [0.75, 0.89]. Response dynamics are predicted with high accuracy (0.78 [0.76, 0.79]), with positive and negative predictive values of 0.90 [0.86, 0.92] and 0.81 [0.78, 0.86], and sensitivity and specificity of 0.71 [0.69, 0.73] and 0.88 [0.83, 0.91] respectively.
CONCLUSIONS
Two patient-specific parameters in a mathematical model can be adaptively learned from early tumor volume evolution to predict subsequent response to therapy and progression risk for individual patients. Future validation is required in an independent dataset and prospective evaluation in another clinical trial.
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Affiliation(s)
| | - Rene Brady
- H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | | | | | - Michael Yu
- H. Lee Moffitt Cancer Center, Tampa, FL, USA
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Ravi H, Stringfield O, De Leon G, Johnston S, Rockne R, Badie B, Brown CE, Swanson K, Gatenby R, Raghunand N. NIMG-74. MULTIPARAMETER MRI INVESTIGATION OF HIGH-GRADE GLIOMA RESPONSE TO CAR T CELL IMMUNOTHERAPY. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.743] [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: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Immunotherapy with engineered CAR T cells is a promising new therapy for glioblastoma, for which predictive and prognostic biomarkers are needed to inform effective intervention. Recently, our group analyzed standard-of-care (SOC) MRI images of long-term and short-term glioblastoma survivors and identified six intratumoral “habitats” of which “Habitat 6” was correlated with survival at diagnosis in high-grade glioma. Based on the MRI characteristics of “Habitat 6”, viz. high enhancement and high edema, we hypothesized that it could be a marker of tumor immune infiltrates. We are studying longitudinal changes in tumor “habitat” composition on MRIs of subjects with recurrent high-grade glioma treated with CAR T cells engineered to target IL13Ra2.
METHODS
MRI scans of the brain were acquired in 6 subjects at 3.0 T at baseline and various times before and after initiation of CAR T cell therapy. FLAIR, T1W and T1W-CE MRI images were registered to T2W images and six intratumoral “habitats” were computed as per our recently published methodology. The six habitats generated at the end of the tumor segmentation process were: “Habitat 1” (low FLAIR, low enhancement), “Habitat 2” (high FLAIR, low enhancement), “Habitat 3” (low FLAIR, medium enhancement), “Habitat 4” (high FLAIR, medium enhancement), “Habitat 5” (low FLAIR, high enhancement), and “Habitat 6” (high FLAIR, high enhancement).
RESULTS
Analysis of temporal changes in the six “habitats” shows an initial increase in both “Habitat 4” and “Habitat 6” following CAR T cell therapy initiation. Subjects with higher absolute volumes of “Habitat 6” at the baseline (pre-treatment) showed longer overall survival. Overall survival is a function of absolute “Habitat 6” volume at baseline, its direction of change immediately post-therapy, the duration of any increase in “Habitat 6” post-treatment, and the “Habitat 6” to “Habitat 4” ratio. Additional subjects are being evaluated to further understand these preliminary observations.
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Affiliation(s)
| | | | | | | | - Russell Rockne
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Behnam Badie
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
| | - Christine E Brown
- City of Hope Beckman Research Institute and Medical Center, Duarte, CA, USA
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Johnston SK, Whitmire P, Massey SC, Kumthekar P, Porter AB, Raghunand N, Gonzalez-Cuyar LF, Mrugala MM, Hawkins-Daarud A, Jackson PR, Hu LS, Sarkaria JN, Wang L, Gatenby RA, Egan KM, Canoll P, Swanson KR. ENvironmental Dynamics Underlying Responsive Extreme Survivors (ENDURES) of Glioblastoma: A Multidisciplinary Team-based, Multifactorial Analytical Approach. Am J Clin Oncol 2019; 42:655-661. [PMID: 31343422 PMCID: PMC7416695 DOI: 10.1097/coc.0000000000000564] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although glioblastoma (GBM) is a fatal primary brain cancer with short median survival of 15 months, a small number of patients survive >5 years after diagnosis; they are known as extreme survivors (ES). Because of their rarity, very little is known about what differentiates these outliers from other patients with GBM. For the purpose of identifying unknown drivers of extreme survivorship in GBM, the ENDURES consortium (ENvironmental Dynamics Underlying Responsive Extreme Survivors of GBM) was developed. This consortium is a multicenter collaborative network of investigators focused on the integration of multiple types of clinical data and the creation of patient-specific models of tumor growth informed by radiographic and histologic parameters. Leveraging our combined resources, the goals of the ENDURES consortium are 2-fold: (1) to build a curated, searchable, multilayered repository housing clinical and outcome data on a large cohort of ES patients with GBM; and (2) to leverage the ENDURES repository for new insights into tumor behavior and novel targets for prolonging survival for all patients with GBM. In this article, the authors review the available literature and discuss what is already known about ES. The authors then describe the creation of their consortium and some preliminary results.
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Affiliation(s)
- Sandra K. Johnston
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
- Department of Radiology, University of Washington, Seattle, WA
| | - Paula Whitmire
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Susan Christine Massey
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Priya Kumthekar
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Luis F. Gonzalez-Cuyar
- Department of Pathology, Neuropathology Division, University of Washington Medical Center, Seattle, WA
| | | | - Andrea Hawkins-Daarud
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Pamela R. Jackson
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Leland S. Hu
- Department of Radiology, Mayo Clinic, Phoenix, AZ
| | | | - Lei Wang
- Departments of Radiology & Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert A. Gatenby
- Cancer Biology and Evolution Program, Moffitt Cancer Center, Tampa, FL
| | | | - Peter Canoll
- Division of Neuropathology, Department of Pathology and Cell Biology, Columbia University School of Medicine, New York, NY
| | - Kristin R. Swanson
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
- Department of Neurosurgery, Mayo Clinic, Phoenix, AZ
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ
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Jeong D, Raghunand N, Hernando D, Poch M, Jeong K, Eck B, Dhillon J. Quantification of sarcomatoid differentiation in renal cell carcinoma on magnetic resonance imaging. Quant Imaging Med Surg 2018; 8:373-382. [PMID: 29928602 DOI: 10.21037/qims.2018.04.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Sarcomatoid differentiation in renal cell carcinoma (sRCC) is histologically characterized by anaplastic changes of renal cell carcinoma (RCC) subtypes, which has been associated with a poor prognosis. sRCC is managed more aggressively than RCC without sarcomatoid components, so pre-operative detection of sarcomatoid differentiation would significantly affect surgical management. The purpose of this study is to compare the quantification of sarcomatoid features in RCCs on pre-operative magnetic resonance imaging (MRI) to standard histological examination. Methods Patients who had nephrectomy at our institution between 2000 and 2015 with pathology proven RCC and pre-operative contrast enhanced MRI abdominal scans were retrospectively reviewed. A custom MATLAB routine calculated the portion of each manually segmented whole tumor with MRI signal suggestive of sarcomatoid involvement based on prior research (MRI%SARC). The primary endpoint compared MRI%SARC to percent sarcomatoid involvement estimated by histological examination (HIST%SARC) using Pearson correlation and Bland Altman analysis. Results A total of 17 patients with sRCC (10 males, age 60.3±11.1 years) and 17 consecutive control patients with clear cell RCC (ccRCC) without sarcomatoid components (10 males, age 64.5±7.6 years) were evaluated. Pearson correlation analysis revealed a strong association between MRI%SARC and HIST%SARC (r=0.782, P<0.001). Bland-Altman analysis demonstrated proportional bias, with a mean bias of 19.29 [95% confidence interval (CI): 9.79-28.79] and with 95% limits of agreement of -16.93 (95% CI: -33.38 to -0.48) to 55.51 (95% CI: 39.06-71.96), suggesting MRI%SARC underestimated values compared to HIST%SARC by 19%. Conclusions Multiparametric pre-operative MRI analysis to quantify sarcomatoid features in RCC correlates with standard histological examination but underestimates percent sarcomatoid involvement.
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Affiliation(s)
- Daniel Jeong
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Natarajan Raghunand
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison. Madison, WI, USA
| | - Michael Poch
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Katherine Jeong
- Department of Internal Hospital Medicine, H. Lee. Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Brendan Eck
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Jasreman Dhillon
- Department of Anatomical Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Chou K, Grass G, Zhang G, Latifi K, Arrington J, Sahebjam S, Raghunand N, Enderling H, Stringfield O, Sarangkasiri S, Forsyth P, Johnstone P, Robinson T, Yu H. Pretreatment T2-Weighted Fluid Attenuated Inversion Recovery (T2-FLAIR pre ) MRI May Improve Gross Tumor Volume Delineation for Recurrent Glioblastoma Treated with Salvage Hypofractionated Stereotactic Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ramanathan RK, Korn RL, Raghunand N, Sachdev JC, Newbold RG, Jameson G, Fetterly GJ, Prey J, Klinz SG, Kim J, Cain J, Hendriks BS, Drummond DC, Bayever E, Fitzgerald JB. Correlation between Ferumoxytol Uptake in Tumor Lesions by MRI and Response to Nanoliposomal Irinotecan in Patients with Advanced Solid Tumors: A Pilot Study. Clin Cancer Res 2017; 23:3638-3648. [PMID: 28159813 DOI: 10.1158/1078-0432.ccr-16-1990] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 11/16/2022]
Abstract
Purpose: To determine whether deposition characteristics of ferumoxytol (FMX) iron nanoparticles in tumors, identified by quantitative MRI, may predict tumor lesion response to nanoliposomal irinotecan (nal-IRI).Experimental Design: Eligible patients with previously treated solid tumors had FMX-MRI scans before and following (1, 24, and 72 hours) FMX injection. After MRI acquisition, R2* signal was used to calculate FMX levels in plasma, reference tissue, and tumor lesions by comparison with a phantom-based standard curve. Patients then received nal-IRI (70 mg/m2 free base strength) biweekly until progression. Two percutaneous core biopsies were collected from selected tumor lesions 72 hours after FMX or nal-IRI.Results: Iron particle levels were quantified by FMX-MRI in plasma, reference tissues, and tumor lesions in 13 of 15 eligible patients. On the basis of a mechanistic pharmacokinetic model, tissue permeability to FMX correlated with early FMX-MRI signals at 1 and 24 hours, while FMX tissue binding contributed at 72 hours. Higher FMX levels (ranked relative to median value of multiple evaluable lesions from 9 patients) were significantly associated with reduction in lesion size by RECIST v1.1 at early time points (P < 0.001 at 1 hour and P < 0.003 at 24 hours FMX-MRI, one-way ANOVA). No association was observed with post-FMX levels at 72 hours. Irinotecan drug levels in lesions correlated with patient's time on treatment (Spearman ρ = 0.7824; P = 0.0016).Conclusions: Correlation between FMX levels in tumor lesions and nal-IRI activity suggests that lesion permeability to FMX and subsequent tumor uptake may be a useful noninvasive and predictive biomarker for nal-IRI response in patients with solid tumors. Clin Cancer Res; 23(14); 3638-48. ©2017 AACR.
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Affiliation(s)
- Ramesh K Ramanathan
- Virginia G Piper Cancer Center, Honor Healthcare, Scottsdale, Arizona. .,Translational Genomics Research Institute, Phoenix, Arizona
| | - Ronald L Korn
- Virginia G Piper Cancer Center, Honor Healthcare, Scottsdale, Arizona.,Imaging Endpoints, Scottsdale, Arizona
| | | | - Jasgit C Sachdev
- Virginia G Piper Cancer Center, Honor Healthcare, Scottsdale, Arizona
| | - Ronald G Newbold
- Virginia G Piper Cancer Center, Honor Healthcare, Scottsdale, Arizona.,Imaging Endpoints, Scottsdale, Arizona
| | - Gayle Jameson
- Virginia G Piper Cancer Center, Honor Healthcare, Scottsdale, Arizona
| | | | - Joshua Prey
- Roswell Park Cancer Institute, Buffalo, New York
| | | | - Jaeyeon Kim
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Jason Cain
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts
| | | | | | - Eliel Bayever
- Merrimack Pharmaceuticals, Inc., Cambridge, Massachusetts
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Landowski TH, Guntle GP, Zhao D, Jagadish B, Mash EA, Dorr RT, Raghunand N. Magnetic Resonance Imaging Identifies Differential Response to Pro-Oxidant Chemotherapy in a Xenograft Model. Transl Oncol 2016; 9:228-35. [PMID: 27267841 PMCID: PMC4907896 DOI: 10.1016/j.tranon.2016.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/16/2016] [Accepted: 04/23/2016] [Indexed: 12/12/2022] Open
Abstract
Induction of oxidative stress is a key component of cancer therapy. Pro-oxidant drugs have been demonstrated to enhance the efficacy of radiotherapy and chemotherapy. An emerging concept is that therapeutic outcomes are dictated by the differential redox buffering reserve in subpopulations of malignant cells, indicating the need for noninvasive biomarkers of tumor redox that can be used for dose identification and response assessment in a longitudinal setting. Magnetic resonance imaging (MRI) enhanced with the thiol-binding contrast agent Gd-LC6-SH, and hemodynamic response imaging (HRI) in combination with hypercapnia and hyperoxia were investigated as biomarkers of the pharmacodynamics of the small molecule pro-oxidant imexon (IMX). Human multiple myeloma cell lines 8226/S and an IMX-resistant variant, 8226/IM10, were established as contralateral tumors in SCID mice. T1slope, an MRI measure of the washout rate of Gd-LC6-SH, was significantly lower post-IMX therapy in 8226/S tumors compared with vehicle controls, indicating treatment-related oxidization of the tumor microenvironment, which was confirmed by analysis of tumor tissue for thiols. T1slope and ex vivo assays for thiols both indicated a more reduced microenvironment in 8226/IM10 tumors following IMX therapy. HRI with hypercapnia challenge revealed IMX inhibition of vascular dilation in 8226/S tumors but not 8226/IM10 tumors, consistent with decreased immunohistochemical staining for smooth muscle actin in treated 8226/S tumors. MRI enhanced with Gd-LC6-SH, and HRI coupled with a hypercapnic challenge provide noninvasive biomarkers of tumor response to the redox modulator imexon.
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Affiliation(s)
- Terry H Landowski
- University of Arizona Cancer Center, The University of Arizona, Tucson, AZ 85724, USA
| | - Gerald P Guntle
- University of Arizona Cancer Center, The University of Arizona, Tucson, AZ 85724, USA
| | - Dezheng Zhao
- University of Arizona Cancer Center, The University of Arizona, Tucson, AZ 85724, USA
| | - Bhumasamudram Jagadish
- Department of Chemistry and Biochemistry, The University of Arizona, Tucson, AZ 85724, USA
| | - Eugene A Mash
- Department of Chemistry and Biochemistry, The University of Arizona, Tucson, AZ 85724, USA
| | - Robert T Dorr
- Department of Pharmacology, The University of Arizona, Tucson, AZ 85724, USA
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Sachdev JC, Ramanathan RK, Raghunand N, Anders C, Munster P, Minton S, Northfelt D, Blanchette S, Campbell K, Lee H, Klinz SG, Hendriks BS, Moyo V, Fitzgerald JB, Korn RL. Abstract OT3-02-14: A phase 1 study in patients with metastatic breast cancer to evaluate the feasibility of magnetic resonance imaging with ferrumoxytol as a potential biomarker for response to treatment with nanoliposomal irinotecan (nal-IRI, MM-398). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-02-14] [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: 11/16/2022]
Abstract
Abstract
Background: Nal-IRI (MM-398, nanoliposomal irinotecan) is designed for extended circulation relative to free irinotecan and to exploit leaky tumor vasculature for enhanced drug delivery to tumors. Tumor deposition of nal-IRI and subsequent conversion to SN-38 in both neoplastic cells and tumor associated macrophages (TAM) may positively correlate with response to therapy. In phase I studies of nal-IRI, activity has been shown in metastatic breast cancer (MBC), pancreatic and colorectal cancer. Ferumoxytol (FMX) is an iron-oxide superparamagnetic nanoparticle that has been used off-label for its MRI contrast properties. FMX has long-circulating pharmacokinetics and is taken up by TAMs with similar distribution patterns to nal-IRI in preclinical models. A single site pilot study established the feasibility of performing quantitative FMX MRI. Thirteen patients with advanced cancer (3 with ER/PR+ MBC) were imaged with FMX MRI and treated with nal-IRI. Median tumor lesion FMX uptake in the pilot study was 32.6 and 34.5 μg/mL at 1 h and 24 h, respectively. Lesions with FMX uptake above the median were associated with greater reductions in tumor size following treatment with nal-IRI as determined by CT lesion measurements. The relationship between FMX levels in tumor lesions and nal-IRI activity may serve as a potential biomarker for nal-IRI deposition and response in solid tumors. This study has been expanded to include additional MBC patients to further evaluate the technical feasibility of FMX MRI at multiple study sites, and to evaluate activity of nal-IRI in patients with MBC.
Trial Design: Three cohorts of 10 patients with MBC in the following categories will be enrolled: ER and/or PR positive/HER2-negative, triple negative (TNBC) and MBC with brain metastases. An imaging phase will be followed by a treatment phase. The imaging phase consists of a baseline MRI scan, FMX infusion, and follow-up MRI scans at 1-4 and 24 h after infusion. The treatment phase begins 1-6 days after imaging and consists of nal-IRI 80 mg/m2 q2w. A pretreatment biopsy is required for correlative studies.
Study Objectives: The primary objective of this multisite expansion is to investigate the feasibility of FMX quantitation in tumor lesions at multiple lesion sites in breast cancer. The secondary objective is to characterize the efficacy of nal-IRI in patients with metastatic breast cancer.
Eligibility Criteria: The key inclusion criteria include patients with MBC, ECOG 0 or 1 with adequate bone marrow reserve and no prior topoisomerase 1 inhibitor or anti-VEGF treatment. ER and/or PR positive/HER2-negative and TNBC patients must have had 1-3 prior lines of chemotherapy in the metastatic setting and have at least 2 measurable lesions. Patients with brain metastasis must be neurologically stable and have new or progressive brain metastases after prior radiation therapy with at least one lesion measuring ≥ 1 cm in longest diameter on gadolinium-enhanced MRI.
Status: This trial is currently recruiting patients.
Citation Format: Sachdev JC, Ramanathan RK, Raghunand N, Anders C, Munster P, Minton S, Northfelt D, Blanchette S, Campbell K, Lee H, Klinz SG, Hendriks BS, Moyo V, Fitzgerald JB, Korn RL. A phase 1 study in patients with metastatic breast cancer to evaluate the feasibility of magnetic resonance imaging with ferrumoxytol as a potential biomarker for response to treatment with nanoliposomal irinotecan (nal-IRI, MM-398). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-02-14.
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Affiliation(s)
- JC Sachdev
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - RK Ramanathan
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - N Raghunand
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - C Anders
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - P Munster
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - S Minton
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - D Northfelt
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - S Blanchette
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - K Campbell
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - H Lee
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - SG Klinz
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - BS Hendriks
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - V Moyo
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - JB Fitzgerald
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
| | - RL Korn
- Virginia G. Piper Cancer Center; Mayo Clinic; Moffitt Cancer Center; University of North Carolina Lineberger Cancer Center; Helen Diller Family Comprehensive Cancer Center; Merrimack Pharmaceuticals, Inc.; Imaging Endpoints
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Hingorani SR, Harris WP, Beck JT, Berdov BA, Wagner SA, Pshevlotsky EM, Tjulandin SA, Gladkov OA, Holcombe RF, Korn R, Raghunand N, Dychter S, Jiang P, Shepard HM, Devoe CE. Phase Ib Study of PEGylated Recombinant Human Hyaluronidase and Gemcitabine in Patients with Advanced Pancreatic Cancer. Clin Cancer Res 2016; 22:2848-54. [PMID: 26813359 DOI: 10.1158/1078-0432.ccr-15-2010] [Citation(s) in RCA: 238] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/24/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE This phase Ib study evaluated the safety and tolerability of PEGylated human recombinant hyaluronidase (PEGPH20) in combination with gemcitabine (Gem), and established a phase II dose for patients with untreated stage IV metastatic pancreatic ductal adenocarcinoma (PDA). Objective response rate and treatment efficacy using biomarker and imaging measurements were also evaluated. EXPERIMENTAL DESIGN Patients received escalating intravenous doses of PEGPH20 in combination with Gem using a standard 3+3 dose-escalation design. In cycle 1 (8 weeks), PEGPH20 was administrated twice weekly for 4 weeks, then once weekly for 3 weeks; Gem was administrated once weekly for 7 weeks, followed by 1 week off treatment. In each subsequent 4-week cycle, PEGPH20 and Gem were administered once weekly for 3 weeks, followed by 1 week off. Dexamethasone (8 mg) was given pre- and post-PEGPH20 administration. Several safety parameters were evaluated. RESULTS Twenty-eight patients were enrolled and received PEGPH20 at 1.0 (n = 4), 1.6 (n = 4), or 3.0 μg/kg (n = 20), respectively. The most common PEGPH20-related adverse events were musculoskeletal and extremity pain, peripheral edema, and fatigue. The incidence of thromboembolic events was 29%. Median progression-free survival (PFS) and overall survival (OS) rates were 5.0 and 6.6 months, respectively. In 17 patients evaluated for pretreatment tissue hyaluronan (HA) levels, median PFS and OS rates were 7.2 and 13.0 months for "high"-HA patients (n = 6), and 3.5 and 5.7 months for "low"-HA patients (n = 11), respectively. CONCLUSIONS PEGPH20 in combination with Gem was well tolerated and may have therapeutic benefit in patients with advanced PDA, especially in those with high HA tumors. Clin Cancer Res; 22(12); 2848-54. ©2016 AACR.
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Affiliation(s)
- Sunil R Hingorani
- Fred Hutchinson Cancer Research Center, Seattle, Washington. University of Washington School of Medicine, Seattle, Washington.
| | - William P Harris
- Fred Hutchinson Cancer Research Center, Seattle, Washington. University of Washington School of Medicine, Seattle, Washington
| | | | - Boris A Berdov
- Medical Radiological Research Center, Obninsk, Russian Federation
| | - Stephanie A Wagner
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Eduard M Pshevlotsky
- Omsk Regional Budget Medical Institution: Clinical Oncological Center, Omsk, Russian Federation
| | - Sergei A Tjulandin
- Russian Oncology Research Center n.a. N.N. Blokhin, Moscow, Russian Federation
| | - Oleg A Gladkov
- Chelyabinsk Regional Clinical Oncology Center, Chelyabinsk, Russian Federation
| | | | | | | | | | - Ping Jiang
- Halozyme Therapeutics, San Diego, California
| | | | - Craig E Devoe
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
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Lickliter JD, Wilson DB, Hendrickson H, Raghunand N, Khor SP, Longacre O, Unger EC. An oxygenation agent and radiation sensitizer, dodecafluoropentane, for the treatment of glioblastoma multiforme. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps2078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ramanathan R, Korn R, Sachdev J, Fetterly G, Jameson G, Marceau K, Marsh V, Raghunand N, Prey J, Klinz S, Kim J, Bayever E, Fitzgerald J. 261 Lesion characterization with ferumoxytol MRI in patients with advanced solid tumors and correlation with treatment response to MM-398, nanoliposomal irinotecan (nal-IRI). Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ramanathan RK, Korn RL, Sachdev JC, Fetterly GJ, Marceau K, Marsh V, Neil JM, Newbold RG, Raghunand N, Prey J, Klinz SG, Bayever E, Fitzgerald JB. Abstract CT224: Pilot study in patients with advanced solid tumors to evaluate feasibility of ferumoxytol (FMX) as tumor imaging agent prior to MM-398, a nanoliposomal irinotecan (nal-IRI). Clin Trials 2014. [DOI: 10.1158/1538-7445.am2014-ct224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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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Raghunand N, Scicinski J, Oronsky B, Guntle G, Bruckheimer E, Korn R. Abstract 2068: RRx-001 oxidation of redox sensitive protein thiols in tumors measured by Gd-LC7-SH enhanced MRI In preclinical tumor models. Tumour Biol 2014. [DOI: 10.1158/1538-7445.am2014-2068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Dragovich T, Laheru D, Dayyani F, Bolejack V, Smith L, Seng J, Burris H, Rosen P, Hidalgo M, Ritch P, Baker AF, Raghunand N, Crowley J, Von Hoff DD. Phase II trial of vatalanib in patients with advanced or metastatic pancreatic adenocarcinoma after first-line gemcitabine therapy (PCRT O4-001). Cancer Chemother Pharmacol 2014; 74:379-87. [PMID: 24939212 DOI: 10.1007/s00280-014-2499-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 05/24/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Vatalanib (PTK 787/ZK22584) is an oral poly-tyrosine kinase inhibitor with strong affinity for platelet-derived growth factor and vascular endothelial growth factor (VEGF) receptors. We conducted an open-label, phase II multicenter therapeutic trial investigating the efficacy and tolerability of vatalanib in patients with metastatic or advanced pancreatic cancer who failed first-line gemcitabine-based therapy. METHODS Vatalanib treatment consisted of a twice daily oral dosing using a "ramp-up schedule," beginning with 250 mg bid during week 1,500 mg bid during week 2, and 750 mg bid on week three and thereafter. The primary objective of this study was to evaluate the 6-month survival rate. RESULTS Sixty-seven patients were enrolled. The median age was 64, and 66% (N = 43) had only one prior regimen. Common grade 3/4 adverse events included hypertension (20%; N = 13), fatigue (17%; N = 11), abdominal pain (17%; N = 11), and elevated alkaline phosphatase (15%; N = 10). Among the 65 evaluable patients, the 6-month survival rate was 29% (95% CI 18-41%) and the median progression-free survival was 2 months. Fifteen patients survived 6 months or more. Two patients had objective partial responses, and 28% of patients had stable disease. Changes in biomarkers including soluble VEGF and vascular endothelial growth factor receptor did not correlate with response to drug. CONCLUSION Vatalanib was well tolerated as a second-line therapy and resulted in favorable 6-month survival rate in patients with metastatic pancreatic cancer, compared with historic controls.
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Affiliation(s)
- T Dragovich
- Banner MD Anderson Cancer Center, 1900 N. Higley Road, Gilbert, AZ, 85234, USA,
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Jagadish B, Ozumerzifon TJ, Roberts SA, Hall GB, Mash EA, Raghunand N. IMPROVED SYNTHESIS OF 10-(2-ALKYLAMINO-2-OXOETHYL)-1,4,7,10-TETRAAZACYCLODODECANE-1,4,7-TRIACETIC ACID DERIVATIVES BEARING ACID-SENSITIVE LINKERS. SYNTHETIC COMMUN 2013; 44. [PMID: 24363464 DOI: 10.1080/00397911.2013.813547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Alkylation of the hydrobromide salts of 1,4,7-tris(methoxycarbonylmethyl)-1,4,7,10-tetraazacyclododecane and 1,4,7-tris(ethoxycarbonylmethyl)-1,4,7,10-tetraazacyclododecane with appropriate α-bromoacetamides, followed by hydrolysis, provides convenient access to 10-(2-alkylamino-2-oxoethyl)-1,4,7,10-tetraazacyclododecane-1,4,7-triacetic acid derivatives that contain acid-sensitive functional groups. The utility of the method is demonstrated by improved syntheses of two known DOTA monoamides bearing acid-sensitive ω-tritylthio alkyl chains in much higher yields based on cyclen as the starting material.
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Affiliation(s)
- Bhumasamudram Jagadish
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ 85721-0041 USA
| | - Tarik J Ozumerzifon
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ 85721-0041 USA
| | - Sue A Roberts
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ 85721-0041 USA
| | - Gabriel B Hall
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ 85721-0041 USA
| | - Eugene A Mash
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ 85721-0041 USA
| | - Natarajan Raghunand
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85721-0041 USA ; Arizona Cancer Center, University of Arizona, Tucson, AZ 85721-0041 USA
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Jagadish B, Guntle GP, Zhao D, Gokhale V, Ozumerzifon TJ, Ahad AM, Mash EA, Raghunand N. Redox-active magnetic resonance imaging contrast agents: studies with thiol-bearing 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetracetic acid derivatives. J Med Chem 2012; 55:10378-86. [PMID: 23148501 DOI: 10.1021/jm300736f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The synthesis and structure-activity relationships of a homologous series of 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid gadolinium(III) complexes bearing thiol-terminated alkyl side chains from three to nine carbons in length are reported. The observed binding with human serum albumin (HSA) of the compounds having C-3 through C-7 side chain lengths was inhibited by homocysteine in a manner consistent with single-site binding. The observed binding with HSA of the compounds having C-8 and C-9 side chain lengths was only partly inhibited by homocysteine, consistent with multisite binding. The binding affinity of the C-7 compound could be related to the HSA oxidation state. 2D 1H-1H NMR TOCSY provided evidence of covalent binding of the europium analog of the C-6 compound to HSA-Cys34. The longitudinal water-proton MRI relaxivities of the gadolinium complexes at 7 T increased upon binding to HSA. On the basis of these results, the C-6 and C-7 compounds were identified as promising redox-sensitive MRI contrast agents.
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Affiliation(s)
- Bhumasamudram Jagadish
- Department of Chemistry and Biochemistry, Arizona Cancer Center, University of Arizona, Tucson, Arizona 85721-0041, United States
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Baker AF, Adab KN, Raghunand N, Chow H, Stratton SP, Squire SW, Boice M, Pestano LA, Kirkpatrick DL, Dragovich T. A phase IB trial of 24-hour intravenous PX-12, a thioredoxin-1 inhibitor, in patients with advanced gastrointestinal cancers. Invest New Drugs 2012; 31:631-641. [PMID: 22711542 DOI: 10.1007/s10637-012-9846-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 05/31/2012] [Indexed: 11/25/2022]
Abstract
We investigated the safety, pharmacokinetics, and pharmacodynamics of PX-12, a thioredoxin-1 (Trx-1) inhibitor, administered as a 24-hour infusion every 7 or 14 days in patients with gastrointestinal malignancies. PX-12 is the first Trx-1 inhibitor to undergo clinical development. The first Phase 1 study of PX-12 demonstrated promising clinical activity, but the 1 and 3 hour-infusion schedules investigated were associated with a strong and irritating odor due to exhalation of one of its metabolites, 2-butanethiol. In an effort to achieve tolerability and achieve a drug exposure level necessary for biological activity, the current study was undertaken. While the maximally tolerated dose was estimated to be 300 mg/m(2) /24 h once a week as the 2-butanethiol expirate was tolerable at that dose level, no evidence of clinical activity was observed. Pharmacokinetic studies of the parent compound PX-12 demonstrated rapid, irreversible binding to plasma components, resulting in low (ng/ml) peak plasma concentrations of non-bound PX-12 during infusion. DCE-MRI was performed pre-and post-infusion in three patients. There were no significant trends observed in changes in plasma Trx-1, vascular endothelial growth factor (VEGF), or beta fibroblast growth factor (FGF-2) pre- or post-treatment. However, there was a trend for a decrease in circulating Trx-1 during the first four PX-12 treatment cycles in patients that had a Trx-1 baseline level >18 ng/mL. Aggregate clinical trial results suggest that further clinical development of PX-12, as an intravenous infusion, is not feasible. However, the Trx-1 pathway remains a target of interest in patients with gastrointestinal malignancies.
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Rajaraman S, Rodriguez JJ, Graff C, Altbach MI, Dragovich T, Sirlin CB, Korn RL, Raghunand N. Automated registration of sequential breath-hold dynamic contrast-enhanced MR images: a comparison of three techniques. Magn Reson Imaging 2011; 29:668-82. [PMID: 21531108 DOI: 10.1016/j.mri.2011.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Revised: 11/04/2010] [Accepted: 02/20/2011] [Indexed: 10/18/2022]
Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is increasingly in use as an investigational biomarker of response in cancer clinical studies. Proper registration of images acquired at different time points is essential for deriving diagnostic information from quantitative pharmacokinetic analysis of these data. Motion artifacts in the presence of time-varying intensity due to contrast enhancement make this registration problem challenging. DCE-MRI of chest and abdominal lesions is typically performed during sequential breath-holds, which introduces misregistration due to inconsistent diaphragm positions and also places constraints on temporal resolution vis-à-vis free-breathing. In this work, we have employed a computer-generated DCE-MRI phantom to compare the performance of two published methods, Progressive Principal Component Registration and Pharmacokinetic Model-Driven Registration, with Sequential Elastic Registration (SER) to register adjacent time-sample images using a published general-purpose elastic registration algorithm. In all three methods, a 3D rigid-body registration scheme with a mutual information similarity measure was used as a preprocessing step. The DCE-MRI phantom images were mathematically deformed to simulate misregistration, which was corrected using the three schemes. All three schemes were comparably successful in registering large regions of interest (ROIs) such as muscle, liver, and spleen. SER was superior in retaining tumor volume and shape, and in registering smaller but important ROIs such as tumor core and tumor rim. The performance of SER on clinical DCE-MRI data sets is also presented.
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Affiliation(s)
- Sivaramakrishnan Rajaraman
- Department of Electrical and Computer Engineering, The University of Arizona, Tucson, AZ 85721-0104, USA
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Jagadish B, Brickert-Albrecht GL, Nichol GS, Mash EA, Raghunand N. On the Synthesis of 1,4,7-Tris(tert-butoxycarbonylmethyl)-1,4,7,10-tetraazacyclododecane. Tetrahedron Lett 2011; 52:2058-2061. [PMID: 21516221 DOI: 10.1016/j.tetlet.2010.10.074] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
1,4,7-Tris(tert-butoxycarbonylmethyl)-1,4,7,10-tetraazacyclododecane is widely used as an intermediate in the preparation of medically important DO3A and DOTA metal chelators. Despite its commercial availability and importance, the literature describing the preparation and properties of the free base is limited and sometimes unclear. We present herein an efficient synthesis of the hydrobromide salt of 1,4,7-tris(tert-butoxycarbonylmethyl)-1,4,7,10-tetraazacyclododecane, characterize this compound spectroscopically and by X-ray crystallographic analysis, describe its simple conversion to the corresponding free base, characterize this compound spectroscopically and by X-ray crystallographic analysis, and make observations on the reactivity of this interesting and useful compound.
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Raghunand N, Guntle GP, Gokhale V, Nichol GS, Mash EA, Jagadish B. Design, synthesis, and evaluation of 1,4,7,10-tetraazacyclododecane-1,4,7-triacetic acid derived, redox-sensitive contrast agents for magnetic resonance imaging. J Med Chem 2010; 53:6747-57. [PMID: 20722424 DOI: 10.1021/jm100592u] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The design and synthesis of three 1,4,7,10-tetraazacyclododecane-1,4,7-triacetic acid (DO3A) derivatives bearing linkers with terminal thiol groups and a preliminary evaluation of their potential for use in assembling redox-sensitive magnetic resonance imaging contrast agents are reported. The linkers were selected on the basis of computational docking with a crystal structure of human serum albumin (HSA). Gd(III)-DO3A and Eu(III)-DO3A complexes were synthesized, and the structure of one complex was established by X-ray crystallographic analysis. The binding to HSA of a Gd(III)-DO3A complex bearing a thiol-terminated 3,6-dioxanonyl chain was competitively inhibited by homocysteine and by the corresponding Eu chelate. Binding to HSA was abolished when the terminal thiol group of this complex was absent. The longitudinal water-proton relaxivities (r(1)) of the three Gd(III)-DO3A complexes and of two Gd(III)-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) complexes were measured in saline at 7 T. The DO3A complexes exhibited smaller r(1) values, in both bound and free states, than the DOTA complexes.
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Affiliation(s)
- Natarajan Raghunand
- Department of Radiology, University of Arizona, Tucson, Arizona 85724-5024, USA
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Read WL, Rosen P, Lee P, Anthony S, Korn R, Raghunand N, Tseng B, Whisnant J, Von Hoff D, Tibes R. Pharmacokinetic and pharmacodynamic results of a 4-hr IV administration phase I study with EPC2407, a novel vascular disrupting agent. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
3569 Background: EPC2407 is a 4-aryl-chromene single isomer microtubulin inhibitor with vascular disrupting and apoptotic activity at nanomolar concentrations. In an earlier phase I study dosing by 1 hr infusions daily x3 on a 21 day cycle, DLT at 21 mg/m2 was pain at tumor sites and vasoconstriction with increases of BP and QTc. MTD was 13 mg/m2 over 1 hr (ASCO 2008, Abst 2531). All drug-related toxicities resolved within an hour of stopping the infusion. Prolonged infusion of EPC2407 to extend exposure of tumor vasculature was designed with administration of EPC2407 over 4 hrs for 3 consecutive days of a 21 day cycle. Eleven patients have received this schedule and their cancers included leiomyosarcoma, colo-rectal, ovary, hepatocellular (2), NSCLC, pancreas, carcinoid, hemangiopericytoma, larynx and small bowel. Results: Doses escalated from 13 to 30 mg/m2 over 4 hours, with MTD determined to be 24 mg/m2. DLTs at 30 mg/m2 were similar to those seen in the 1 hr infusion, with pain at tumor sites in 1 participant and asymptomatic ST depression in a second. Other toxicities were also similar and included transient hypertension. QTc increases were not significant and no new toxicities were encountered. T1/2 with 4 hr infusion was ∼2hr, also seen with 1 hr infusion. AUC and Cmax values were similar to that predicted from the 1 hr data except AUC at 13 mg/m2 was lower than expected. DCE-MRI was done at baseline and after infusion on day 3, cycle 1. Analysis to date of DCE-MRI data of 4 patients showed a median decrease of 40% in both tumor permeability (Ktrans) and tumor perfusion volume (Vp). The two patients with hepatocellular carcinoma had notable stable disease and clear clinical benefit. Both patients received 18 mg/m2 dose, with one receiving 7 cycles over 5 months, and the other still on study (cycle 6) with stable disease for at least 4 cycles. Conclusions: EPC2407 shows clinical promise, with infusion-associated toxicities characteristic of the VDA drug class but without sustained or cumulative toxicity. Studies combining EPC2407 with conventional cytotoxic/cytostatic regimens are being designed. [Table: see text]
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Affiliation(s)
- W. L. Read
- University of California at San Diego, San Diego, CA; Tower Cancer Research Foundation, Beverly Hills, CA; Scottsdale Clinical Research Inst/TGen, Scottsdale, AZ; University of Arizona, Tucson, AZ; Epicept Corp, San Diego, CA
| | - P. Rosen
- University of California at San Diego, San Diego, CA; Tower Cancer Research Foundation, Beverly Hills, CA; Scottsdale Clinical Research Inst/TGen, Scottsdale, AZ; University of Arizona, Tucson, AZ; Epicept Corp, San Diego, CA
| | - P. Lee
- University of California at San Diego, San Diego, CA; Tower Cancer Research Foundation, Beverly Hills, CA; Scottsdale Clinical Research Inst/TGen, Scottsdale, AZ; University of Arizona, Tucson, AZ; Epicept Corp, San Diego, CA
| | - S. Anthony
- University of California at San Diego, San Diego, CA; Tower Cancer Research Foundation, Beverly Hills, CA; Scottsdale Clinical Research Inst/TGen, Scottsdale, AZ; University of Arizona, Tucson, AZ; Epicept Corp, San Diego, CA
| | - R. Korn
- University of California at San Diego, San Diego, CA; Tower Cancer Research Foundation, Beverly Hills, CA; Scottsdale Clinical Research Inst/TGen, Scottsdale, AZ; University of Arizona, Tucson, AZ; Epicept Corp, San Diego, CA
| | - N. Raghunand
- University of California at San Diego, San Diego, CA; Tower Cancer Research Foundation, Beverly Hills, CA; Scottsdale Clinical Research Inst/TGen, Scottsdale, AZ; University of Arizona, Tucson, AZ; Epicept Corp, San Diego, CA
| | - B. Tseng
- University of California at San Diego, San Diego, CA; Tower Cancer Research Foundation, Beverly Hills, CA; Scottsdale Clinical Research Inst/TGen, Scottsdale, AZ; University of Arizona, Tucson, AZ; Epicept Corp, San Diego, CA
| | - J. Whisnant
- University of California at San Diego, San Diego, CA; Tower Cancer Research Foundation, Beverly Hills, CA; Scottsdale Clinical Research Inst/TGen, Scottsdale, AZ; University of Arizona, Tucson, AZ; Epicept Corp, San Diego, CA
| | - D. Von Hoff
- University of California at San Diego, San Diego, CA; Tower Cancer Research Foundation, Beverly Hills, CA; Scottsdale Clinical Research Inst/TGen, Scottsdale, AZ; University of Arizona, Tucson, AZ; Epicept Corp, San Diego, CA
| | - R. Tibes
- University of California at San Diego, San Diego, CA; Tower Cancer Research Foundation, Beverly Hills, CA; Scottsdale Clinical Research Inst/TGen, Scottsdale, AZ; University of Arizona, Tucson, AZ; Epicept Corp, San Diego, CA
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Robey IF, Baggett BK, Kirkpatrick ND, Roe DJ, Dosescu J, Sloane BF, Hashim AI, Morse DL, Raghunand N, Gatenby RA, Gillies RJ. Bicarbonate increases tumor pH and inhibits spontaneous metastases. Cancer Res 2009; 69:2260-8. [PMID: 19276390 DOI: 10.1158/0008-5472.can-07-5575] [Citation(s) in RCA: 446] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The external pH of solid tumors is acidic as a consequence of increased metabolism of glucose and poor perfusion. Acid pH has been shown to stimulate tumor cell invasion and metastasis in vitro and in cells before tail vein injection in vivo. The present study investigates whether inhibition of this tumor acidity will reduce the incidence of in vivo metastases. Here, we show that oral NaHCO(3) selectively increased the pH of tumors and reduced the formation of spontaneous metastases in mouse models of metastatic breast cancer. This treatment regimen was shown to significantly increase the extracellular pH, but not the intracellular pH, of tumors by (31)P magnetic resonance spectroscopy and the export of acid from growing tumors by fluorescence microscopy of tumors grown in window chambers. NaHCO(3) therapy also reduced the rate of lymph node involvement, yet did not affect the levels of circulating tumor cells, suggesting that reduced organ metastases were not due to increased intravasation. In contrast, NaHCO(3) therapy significantly reduced the formation of hepatic metastases following intrasplenic injection, suggesting that it did inhibit extravasation and colonization. In tail vein injections of alternative cancer models, bicarbonate had mixed results, inhibiting the formation of metastases from PC3M prostate cancer cells, but not those of B16 melanoma. Although the mechanism of this therapy is not known with certainty, low pH was shown to increase the release of active cathepsin B, an important matrix remodeling protease.
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Affiliation(s)
- Ian F Robey
- Arizona Cancer Center, University of Arizona, Tucson, Arizona, USA
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Morse DL, Carroll D, Day S, Gray H, Sadarangani P, Murthi S, Job C, Baggett B, Raghunand N, Gillies RJ. Characterization of breast cancers and therapy response by MRS and quantitative gene expression profiling in the choline pathway. NMR Biomed 2009; 22:114-27. [PMID: 19016452 PMCID: PMC4130559 DOI: 10.1002/nbm.1318] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Tumor choline metabolites have potential for use as diagnostic indicators of breast cancer phenotype and can be non-invasively monitored in vivo by MRS. Extract studies have determined that the principle diagnostic component of these peaks is phosphocholine (PCho), the biosynthetic precursor to the membrane phospholipid, phosphatidylcholine (PtdCho). The ability to resolve and quantify PCho in vivo would improve the accuracy of this putative diagnostic tool. In addition, determining the biochemical mechanisms underlying these metabolic perturbations will improve the understanding of breast cancer and may suggest potential molecular targets for drug development. Reported herein is the in vivo resolution and quantification of PCho and glycerophosphocholine (GPC) in breast cancer xenografts in SCID mice via image-guided 31P MRS, localized to a single voxel. Tumor metabolites are also detected using ex vivo extracts and high-resolution NMR spectroscopy and are quantified in the metastatic tumor line, MDA-mb-231. Also reported is the quantification of cytosolic and lipid metabolites in breast cells of differing cancer phenotype, and the identification of metabolites that differ among these cell lines. In cell extracts, PCho and the PtdCho breakdown products, lysophosphatidylcholine, GPC and glycerol 3-phosphate, are all raised in breast cancer lines relative to an immortalized non-malignant line. These metabolic differences are in direct agreement with differences in expression of genes encoding enzymes in the choline metabolic pathway. Results of this study are consistent with previous studies, which have concluded that increased choline uptake, increased choline kinase activity, and increased phosholipase-mediated turnover of PtdCho contribute to the observed increase in PCho in breast cancer. In addition, this study presents evidence suggesting a specific role for phospholipase A2-mediated PtdCho catabolism. Gene expression changes following taxane therapy are also reported and are consistent with previously reported changes in choline metabolites after the same therapy in the same tumor model.
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MESH Headings
- Animals
- Cell Extracts
- Cell Line, Tumor
- Choline/metabolism
- Docetaxel
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic/drug effects
- Genes, Neoplasm
- Humans
- Magnetic Resonance Spectroscopy
- Mammary Neoplasms, Animal/drug therapy
- Mammary Neoplasms, Animal/genetics
- Mammary Neoplasms, Animal/metabolism
- Mammary Neoplasms, Animal/pathology
- Metabolic Networks and Pathways/drug effects
- Metabolic Networks and Pathways/genetics
- Mice
- Mice, SCID
- Phenotype
- Phosphatidylcholines/metabolism
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Taxoids/pharmacology
- Taxoids/therapeutic use
- Xenograft Model Antitumor Assays
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Affiliation(s)
- David L. Morse
- BIO5 Institute, The University of Arizona, Tucson, AZ 85724, USA
| | - Danielle Carroll
- Department of Radiology, The University of Arizona, Medical Research Building, P.O. Box 245215, Tucson, AZ 85724, USA
| | - Sam Day
- Department of Radiology, The University of Arizona, Medical Research Building, P.O. Box 245215, Tucson, AZ 85724, USA
| | - Heather Gray
- Department of Radiology, The University of Arizona, Medical Research Building, P.O. Box 245215, Tucson, AZ 85724, USA
| | - Pooja Sadarangani
- Department of Radiology, The University of Arizona, Medical Research Building, P.O. Box 245215, Tucson, AZ 85724, USA
| | - Shiva Murthi
- Department of Radiology, The University of Arizona, Medical Research Building, P.O. Box 245215, Tucson, AZ 85724, USA
| | - Constantin Job
- Arizona Research Laboratories Division of Biotechnology, The University of Arizona, Tucson, AZ, 85721, USA
| | - Brenda Baggett
- Department of Radiology, The University of Arizona, Medical Research Building, P.O. Box 245215, Tucson, AZ 85724, USA
| | - Natarajan Raghunand
- Department of Radiology, The University of Arizona, Medical Research Building, P.O. Box 245215, Tucson, AZ 85724, USA
| | - Robert J. Gillies
- Department of Radiology, The University of Arizona, Medical Research Building, P.O. Box 245215, Tucson, AZ 85724, USA
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Abstract
Microvascular permeability is a pharmacologic indicator of tumor response to therapy, and it is expected that this biomarker will evolve into a clinical surrogate endpoint and be integrated into protocols for determining patient response to antiangiogenic or antivascular therapies. This review discusses the physiological context of vessel permeability in an imaging setting, how it is affected by active and passive transport mechanisms, and how it is described mathematically for both theoretical and complex dynamic microvessel membranes. Many research groups have established dynamic-enhanced imaging protocols for estimating this important parameter. This review discusses those imaging modalities, the advantages and disadvantages of each, and how they compare in terms of their ability to deliver information about therapy-associated changes in microvessel permeability in humans. Finally, this review discusses future directions and improvements needed in these areas.
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Affiliation(s)
- Dominique Jennings
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona
| | | | - Robert J. Gillies
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona
- Department of Physiology, The University of Arizona, Tucson, Arizona
- Department of Biochemistry, The University of Arizona, Tucson, Arizona
- Department of Radiology, The University of Arizona, Tucson, Arizona
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Morse DL, Raghunand N, Sadarangani P, Murthi S, Job C, Day S, Howison C, Gillies RJ. Response of choline metabolites to docetaxel therapy is quantified in vivo by localized (31)P MRS of human breast cancer xenografts and in vitro by high-resolution (31)P NMR spectroscopy of cell extracts. Magn Reson Med 2007; 58:270-80. [PMID: 17654590 DOI: 10.1002/mrm.21333] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [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] [Indexed: 11/11/2022]
Abstract
Choline-containing compounds (CCCs) are elevated in breast cancer, and detected in vivo by the (1)H MRS total choline (tCho) resonance (3.25 ppm) and the (31)P MRS phosphomonoester (PME) resonance (3.8 ppm). Both the tCho and PME resonances decrease early after initiation of successful therapy. The single major component of these composite resonances, phosphocholine (PCho), also responds to therapy by decreasing. The ability to resolve and quantify PCho in vivo would thus increase the sensitivity of this biomarker for early detection of therapeutic response. Herein, the in vivo resolution and quantification of PCho is reported in human mouse xenograft tumors of the human breast cancer cell lines MCF-7 and MDA-mb-231. Significant decreases in tumor PCho are observed within 2 to 4 d posttreatment with the antimicrotubule drug, docetaxel. To determine whether these decreases are a general tumor response or an intracellular metabolic response, high-resolution NMR spectroscopy was performed on extracts of cells treated with docetaxel. Significant decreases in intracellular PCho and increases in glycerophosphocholine (GPC) were observed. These decreases are coincident with other tumor and cellular responses such as tumor growth delay (TGD), cell-cycle arrest, and modes of cell death such as mitotic catastrophe, necrosis, and apoptosis, with mitotic catastrophe predominating.
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Affiliation(s)
- David L Morse
- The University of Arizona, BIO5 Institute, Arizona Cancer Center, Tucson, Arizona 85724, USA.
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47
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Raghunand N, Jagadish B, Trouard TP, Galons JP, Gillies RJ, Mash EA. Redox-sensitive contrast agents for MRI based on reversible binding of thiols to serum albumin. Magn Reson Med 2006; 55:1272-80. [PMID: 16700014 PMCID: PMC1808246 DOI: 10.1002/mrm.20904] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
DOTA-based complexes of gadolinium (Gd) bearing a thiol moiety on a propyl or hexyl arm were synthesized. It was hypothesized that these complexes would form reversible covalent linkages with human serum albumin (HSA), which contains a reactive thiol at cysteine-34. The binding constant of the hexyl complex to HSA was measured to be 64 mM(-1) and decreased to 17, 6.1, and 3.6 mM(-1) in the presence of 0.5, 1, and 2 mM homocysteine, respectively. The binding constant of the propyl complex to HSA was significantly lower (5.0 mM(-1)) and decreased to 2.0, 1.5, and 0.87 mM(-1) in the presence of 0.5, 1, and 2 mM homocysteine, respectively. The longitudinal water-proton relaxivities of the hexyl and propyl complexes at 37 degrees C and 4.7 T were 2.3 and 2.9 mM(-1) s(-1), respectively, in saline. The relaxivities of the HSA-bound forms of the hexyl and propyl complexes were calculated to be 5.3 and 4.5 mM(-1) s(-1), respectively. The in vivo pharmacokinetics of both thiol complexes were altered by a chase of homocysteine but not saline, while the washout of GdDTPA was unaffected by either chase. Such redox-sensitive reversible binding of Gd complexes to plasma albumin can be exploited for imaging tissue redox and the blood-pool by MRI.
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48
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Abstract
Noninvasive techniques for measurement of tissue pH can be invaluable in assessing disease extent and response to therapy in a variety of pathological conditions, such as renal acidosis and alkalosis, and cancers. We present the details of three techniques for noninvasive measurement of tissue pH: magnetic resonance spectroscopy (MRS), magnetic resonance spectroscopic imaging (MRSI), and contrast-enhanced magnetic resonance imaging (MRI). These techniques exploit the pH-sensitivity of three different molecules, 3-aminopropylphosphonate (3-APP), (+/-) 2-imidazole-1-yl-3-ethoxycarbonyl propionic acid (IEPA), and 1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetrakis(acetamidomethylenephosphonic acid) (Gd-DOTA-4AmP), to examine local extracellular pH in vivo. The level of detail presented will enable nonnovice users of MRS and MRI to reproduce these methodologies in their own laboratories.
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49
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Garcia-Martin ML, Martinez GV, Raghunand N, Sherry AD, Zhang S, Gillies RJ. High resolution pHe imaging of rat glioma using pH-dependent relaxivity. Magn Reson Med 2006; 55:309-15. [PMID: 16402385 DOI: 10.1002/mrm.20773] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [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: 11/10/2022]
Abstract
Previous studies using MR spectroscopy have shown that the extracellular pH (pH(e)) of tumors is acidic compared to normal tissues. This has a number of important sequelae that favor the emergence of more aggressive and therapy-resistant tumors. New MRI methods based on pH-sensitive T1 relaxivity are an attractive alternative to previous spectroscopic methods, as they allow improvements in spatial and temporal resolution. Recently, pH-dependent GdDOTA-4AmP5- and a pH-independent analog, GdDOTP5-, were used to image renal pH in mice. The current study has used a similar approach to image pH(e) in rat gliomas. Significant differences were observed compared to the renal study. First, the relaxivity of GdDOTP5- was found to be affected by the higher extracellular protein content of tumors. Second, the pixel-by-pixel analysis of the GdDOTP5- and GdDOTA-4AmP5- pharmacokinetics showed significant dispersion, likely due to the temporal fluctuations in tumor perfusion. However, there was a robust correlation between the maximal enhancements produced by the two boluses. Therefore, to account for the local time-courses differences, pH(e) maps were calculated at the time of maximal enhancement in each pixel. Finally, the comparison of the pH(e) and the time to maximal intensity maps revealed an inverse relationship between pH(e) and tumor perfusion.
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Affiliation(s)
- Maria L Garcia-Martin
- Department of Biochemistry and Molecular Biophysics, Arizona Cancer Center, The University of Arizona, Tucson, AZ 85724-5024, USA
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50
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Jordan BF, Runquist M, Raghunand N, Baker A, Williams R, Kirkpatrick L, Powis G, Gillies RJ. Dynamic contrast-enhanced and diffusion MRI show rapid and dramatic changes in tumor microenvironment in response to inhibition of HIF-1alpha using PX-478. Neoplasia 2005; 7:475-85. [PMID: 15967100 PMCID: PMC1501160 DOI: 10.1593/neo.04628] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [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: 09/27/2004] [Revised: 11/19/2004] [Accepted: 11/23/2004] [Indexed: 12/27/2022] Open
Abstract
PX-478 is a new agent known to inhibit the hypoxia-responsive transcription factor, HIF-1alpha, in experimental tumors. The current study was undertaken in preparation for clinical trials to determine which noninvasive imaging endpoint(s) is sensitive to this drug's actions. Dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance imaging (MRI) were used to monitor acute effects on tumor hemodynamics and cellularity, respectively. Mice bearing human xenografts were treated either with PX-478 or vehicle, and imaged over time. DW imaging was performed at three b values to generate apparent diffusion coefficient of water (ADCw) maps. For DCE-MRI, a macromolecular contrast reagent, BSA-Gd-DTPA, was used to determine vascular permeability and vascular volume fractions. PX-478 induced a dramatic reduction in tumor blood vessel permeability within 2 hours after treatment, which returned to baseline by 48 hours. The anti-VEGF antibody, Avastin, reduced both the permeability and vascular volume. PX-478 had no effect on the perfusion behavior of a drug-resistant tumor system, A-549. Tumor cellularity, estimated from ADCw, was significantly decreased 24 and 36 hours after treatment. This is the earliest significant response of ADC to therapy yet reported. Based on these preclinical findings, both of these imaging endpoints will be included in the clinical trial of PX-478.
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Affiliation(s)
- Bénédicte F Jordan
- Department of Biochemistry, University of Arizona Health Sciences Center, Tucson, AZ 85724, USA
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