Imaging of Tumor Angiogenesis for Radiologists—Part 2: Clinical Utility

García‐Figueiras, Roberto; Padhani, Anwar R.; Beer, Ambros J.; Baleato-González, Sandra; Vilanova, Joan C.; Luna, Antonio; Oleaga, Laura; Gómez-Caamaño, Antonio; Koh, Dow‐Mu

doi:10.1067/j.cpradiol.2015.02.009

Cited by 15 publications

(11 citation statements)

References 59 publications

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“…However, K trans denotes a context-dependent (including degree of tumor perfusion and MRI acquisition setup/equipment) complex combination of tissue blood flow and permeability weighted to varying extents. In tumors where the variable largely represents perfusion due to limited contrast delivery however, K trans can transiently increase with anti-angiogenic therapy as a result of vascular normalization and changes in local vasodilatory factors, followed by a reduction associated with decreases in neovasculature and endothelial cell apoptosis (vascular pruning); hence, timing of scanning, type of contrast, and sequence can make assessment of changes in DCE-MRI parameters difficult to interpret [51,52]. Moreover, K trans remains an indirect measure of angiogenesis, as it is a measure of vascular permeability influenced by blood flow, capillary surface area, and physiological factors [53], and the lack of standardization of imaging acquisition and data analysis with DCE-MRI also remains a clinical limitation.…”

Section: Discussionmentioning

confidence: 99%

[18F]Fluciclatide PET as a biomarker of response to combination therapy of pazopanib and paclitaxel in platinum-resistant/refractory ovarian cancer

Sharma

Valls

Inglese

et al. 2019

Eur J Nucl Med Mol Imaging

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Background Angiogenesis is a driver of platinum resistance in ovarian cancer. We assessed the effect of combination pazopanib and paclitaxel followed by maintenance pazopanib in patients with platinum-resistant/refractory ovarian cancer. Integrins α v β 3 and α v β 5 are both upregulated in tumor-associated vasculature. [ 18 F]Fluciclatide is a novel PET tracer that has high affinity for integrins α v β 3/5 , and was used to assess the anti-angiogenic effect of pazopanib. Patients and methodsWe conducted an open-label, phase Ib study in patients with platinum-resistant/refractory ovarian cancer. Patients received 1 week of single-agent pazopanib (800 mg daily) followed by combination therapy with weekly paclitaxel (80 mg/m 2 ). Following completion of 18 weeks of combination therapy, patients continued with single-agent pazopanib until disease progression. Dynamic [ 18 F]fluciclatide-PET imaging was conducted at baseline and after 1 week of pazopanib. Response (RECIST 1.1), toxicities, and survival outcomes were recorded. Circulating markers of angiogenesis were assessed with therapy. Results Fourteen patients were included in the intention-to-treat analysis. Complete and partial responses were seen in seven patients (54%). Median progression-free survival (PFS) was 10.63 months, and overall survival (OS) was 18.5 months. Baseline [ 18 F]fluciclatide uptake was predictive of long PFS. Elevated baseline circulating angiopoietin and fibroblast growth factor (FGF) were predictive of greater reduction in SUV 60,mean following pazopanib. Kinetic modeling of PET data indicated a reduction in K 1 and K i following pazopanib indicating reduced radioligand delivery and retention. Conclusions Combination therapy followed by maintenance pazopanib is effective and tolerable in platinum-resistant/refractory ovarian cancer. [ 18 F]Fluciclatide-PET uptake parameters predict clinical outcome with pazopanib therapy indicating an antiangiogenic response.

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Section: Discussionmentioning

confidence: 99%

[18F]Fluciclatide PET as a biomarker of response to combination therapy of pazopanib and paclitaxel in platinum-resistant/refractory ovarian cancer

Sharma

Valls

Inglese

et al. 2019

Eur J Nucl Med Mol Imaging

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“…Angiogenesis is a key cancer hallmark required for invasive tumor growth and metastasis development and constitutes a basic target in the therapy of cancer. Imaging modalities used to evaluate tumor neovasculature mainly include CT, MRI, or US [120][121][122][123][124][125]. All of them have strengths and weaknesses regarding availability, sensitivity, accuracy, biological significance of the obtained data, technical reproducibility, methods for image quantification, provided parameters, and the anatomical areas that can be imaged.…”

Section: Evaluation Of Tumor Vasculature-angiogenesismentioning

confidence: 99%

“…The combination of these vascular characteristics causes that the overall BF tended to be significantly lower in tumors and the subsequent development of hypoxia. Unfortunately, imaging techniques used in clinical practice usually check the effects of angiogenesis on tumor vasculature, not the angiogenic process itself [120][121][122][123][124][125][126].…”

Section: Biological Bases Of Angiogenesismentioning

confidence: 99%

“…Different imaging techniques with and without the use of exogenous contrast media have been used for the functional evaluation of tumor vasculature. DCE techniques including CTP, DCE-US, DCE-MRI, or DSC-MRI are the most common imaging methods for assessing tumor vasculature [120][121][122][123][124][125][126]. These imaging techniques acquire a series of images through a region of interest before, during, and after the intravenous injection of a contrast agent.…”

Section: Technical Featuresmentioning

confidence: 99%

“…and the model of analysis of enhancement kinetics directly influence the calculation of vascular parameters. Analysis and interpretation of DCE-imaging data can be performed with different approaches [120,121]:…”

Section: Interpretation Guidelinesmentioning

confidence: 99%

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How clinical imaging can assess cancer biology

et al. 2019

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Human cancers represent complex structures, which display substantial inter-and intratumor heterogeneity in their genetic expression and phenotypic features. However, cancers usually exhibit characteristic structural, physiologic, and molecular features and display specific biological capabilities named hallmarks. Many of these tumor traits are imageable through different imaging techniques. Imaging is able to spatially map key cancer features and tumor heterogeneity improving tumor diagnosis, characterization, and management. This paper aims to summarize the current and emerging applications of imaging in tumor biology assessment.

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