The role of early magnetic resonance imaging in predicting survival on bevacizumab for recurrent glioblastoma: Results from a prospective clinical trial (CABARET)

Field, Kathryn; Phal, Pramit M.; Fitt, Greg; Goh, Christine; Nowak, Anna K.; Rosenthal, Mark; Simes, John; Barnes, Elizabeth H; Sawkins, Kate; Cher, Lawrence; Hovey, Elizabeth; Wheeler, Helen

doi:10.1002/cncr.30838

Cited by 9 publications

(3 citation statements)

References 29 publications

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“…Galla et al [33] showed that change in minimum ADC in the enhancing portion of the tumor after superselective intra-arterial bevacizumab therapy was associated with an increased risk of death (hazard ratio = 2.0, 95% confidence interval(CI) [1.04-3.79], p = .038), adjusting for age, tumor size, BV dose, and prior IV BV treatments. Field et al [34] concluded that early progression on MRI appears to be a robust marker of a poor prognosis for patients on bevacizumab. Mardor et al [35] described the use of diffusion weighted imaging (ADC and Radial diffusivity) from pretreatment MRI, and showed mild correlation with response, defined as relative change in the tumor size, but they did not report PFS6 or OS.…”

Section: Discussionmentioning

confidence: 99%

Cerebral blood volume and apparent diffusion coefficient – Valuable predictors of non-response to bevacizumab treatment in patients with recurrent glioblastoma

Petrova

Korfiatis

Petr

et al. 2019

Journal of the Neurological Sciences

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Background: Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults. The core of standard of care for newly diagnosed GBM was established in 2005 and includes maximum feasible surgical resection followed by radiation and temozolomide, with subsequent temozolomide with or without tumortreating fields. Unfortunately, nearly all patients experience a recurrence. Bevacizumab (BV) is a commonly used second-line agent for such recurrences, but it has not been shown to impact overall survival, and short-term response is variable. Methods: We collected MRI perfusion and diffusion images from 54 subjects with recurrent GBM treated only with radiation and temozolomide. They were subsequently treated with BV. Using machine learning, we created a model to predict short term response (6 months) and overall survival. We set time thresholds to maximize the separation of responders/survivors versus non-responders/short survivors. Results: We were able to segregate 21 (68%) of 31 subjects into unlikely to respond categories based on Progression Free Survival at 6 months (PFS6) criteria. Twenty-two (69%) of 32 subjects could similarly be identified as unlikely to survive long using the machine learning algorithm. Conclusion: With the use of machine learning techniques to evaluate imaging features derived from pre-and post-treatment multimodal MRI, it is possible to identify an important fraction of patients who are either highly unlikely to respond, or highly likely to respond. This can be helpful is selecting patients that either should or should not be treated with BV.

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Section: Discussionmentioning

confidence: 99%

Cerebral blood volume and apparent diffusion coefficient – Valuable predictors of non-response to bevacizumab treatment in patients with recurrent glioblastoma

Petrova

Korfiatis

Petr

et al. 2019

Journal of the Neurological Sciences

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“…Therefore, early response evaluation seems more reasonable. The analysis of MRI imaging data in the CABARET trial clearly showed that early MRI (after every treatment cycle) had prognostic value for overall survival (20). Likewise, in this study, we developed a surrogate imaging biomarker, ERI, to quantitatively measure the anti-edema effect of BEV as an indirect evaluation of the response of the patient to BEV therapy.…”

Section: Discussionmentioning

confidence: 92%

The relationship between the degree of brain edema regression and changes in cognitive function in patients with recurrent glioma treated with bevacizumab and temozolomide

Wang¹,

Chen²,

Qiu³

et al. 2021

Quant Imaging Med Surg

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Background: This retrospective study aims to assess the impacts on cognitive status and quality of life in recurrent high-grade glioma patients treated with temozolomide (TMZ), either alone or in combination with bevacizumab (BEV), and explore the relationship between the brain edema regression, BEV use, and cognitive status.Methods: A total of 125 patients with recurrent high-grade glioma were enrolled in this study, of which 65 patients were treated with BEV (5-10 mg/kg IV every 2 weeks) plus TMZ (200 mg/m 2 every 28 days, d1-5), and 60 patients were treated with TMZ (200 mg/m 2 every 28 days, d1-5) alone. The treatment response was evaluated using the Response Assessment in Neuro-Oncology (RANO) criteria. Tumor-associated edema was evaluated with T2WI magnetic resonance imaging (MRI) and quantitative T2 mapping sequence, and an Edema Regression Index was designed to quantify volumetric changes in edema imaging after every treatment cycle. Cognitive intelligence state and quality of life were evaluated using the Mini-Mental State Examination (MMSE) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30).Results: Radiologically, the partial response rate was 78.5% in the BEV + TMZ group and 38.3% in the TMZ group. After the first cycle of treatment, the mean score of the MMSE was 21.1±2.0 and 24.1±1.4 (P<0.001) in the TMZ group and the BEV + TMZ group, respectively. In the functioning domains of the QLQ-C30, scales of physical functioning, emotional functioning and cognitive functioning were 43.0±7.0 vs. 61.7±12.5 (P<0.001), 44.5±8.8 vs. 63.4±6.9 (P<0.001) and 42.4±8.8 vs. 63.7±12.0 (P<0.001) in the TMZ group and the BEV + TMZ group, respectively. In the BEV + TMZ group, a correlation between the Edema Regression Index and improvement in cognitive status and quality of life was observed. Patients with Edema Regression Index scores higher than 50% gained a 25.6% increase in the mean MMSE score from 19.9±1.6 to 25.0±1.1 (P<0.001). In the BEV + TMZ group, physical functioning, emotional functioning, and cognitive functioning increased by 76.8%, 53.1%, and 81.5%, respectively, while scores of nausea/vomiting decreased by 40.3% to 32.1. Patients with no evident edema observed in the pre-BEV MRI scans were given a prolonged four-cycle course of BEV. No significant improvement was observed in the MMSE score and the QLQ score with additional cycles of BEV.

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“…Early MRI progression was a strong independent predictor of mortality. 370 PMID: 28678383 T2WI and DCE-MRI Bevacizumab (+chemoradiation therapy) VEGF Glioblastoma 232 At weeks 6 and 12 of treatment, increases in baseline necrosis and de novo necrosis were strongly associated with worse OS and PFS. 371 PMID: 31076534 TME mapping Bevacizumab VEGF Glioblastoma 18 Higher percentage of neovascularization and active tumor in baseline indicated poor or no treatment response.…”

Section: Application Of Molecular Imaging In Targeted Therapymentioning

confidence: 99%

Molecular and functional imaging in cancer-targeted therapy: current applications and future directions

Bai

Qiu

Zhang

2023

Sig Transduct Target Ther

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Targeted anticancer drugs block cancer cell growth by interfering with specific signaling pathways vital to carcinogenesis and tumor growth rather than harming all rapidly dividing cells as in cytotoxic chemotherapy. The Response Evaluation Criteria in Solid Tumor (RECIST) system has been used to assess tumor response to therapy via changes in the size of target lesions as measured by calipers, conventional anatomically based imaging modalities such as computed tomography (CT), and magnetic resonance imaging (MRI), and other imaging methods. However, RECIST is sometimes inaccurate in assessing the efficacy of targeted therapy drugs because of the poor correlation between tumor size and treatment-induced tumor necrosis or shrinkage. This approach might also result in delayed identification of response when the therapy does confer a reduction in tumor size. Innovative molecular imaging techniques have rapidly gained importance in the dawning era of targeted therapy as they can visualize, characterize, and quantify biological processes at the cellular, subcellular, or even molecular level rather than at the anatomical level. This review summarizes different targeted cell signaling pathways, various molecular imaging techniques, and developed probes. Moreover, the application of molecular imaging for evaluating treatment response and related clinical outcome is also systematically outlined. In the future, more attention should be paid to promoting the clinical translation of molecular imaging in evaluating the sensitivity to targeted therapy with biocompatible probes. In particular, multimodal imaging technologies incorporating advanced artificial intelligence should be developed to comprehensively and accurately assess cancer-targeted therapy, in addition to RECIST-based methods.

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The role of early magnetic resonance imaging in predicting survival on bevacizumab for recurrent glioblastoma: Results from a prospective clinical trial (CABARET)

Abstract: In this study, early progression on MRI appears to be a robust marker of a poor prognosis for patients on bevacizumab. Cancer 2017;123:3576-82. © 2017 American Cancer Society.

Cited by 9 publications

References 29 publications

Cerebral blood volume and apparent diffusion coefficient – Valuable predictors of non-response to bevacizumab treatment in patients with recurrent glioblastoma

Cerebral blood volume and apparent diffusion coefficient – Valuable predictors of non-response to bevacizumab treatment in patients with recurrent glioblastoma

The relationship between the degree of brain edema regression and changes in cognitive function in patients with recurrent glioma treated with bevacizumab and temozolomide

Molecular and functional imaging in cancer-targeted therapy: current applications and future directions

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