Rationale and Objectives
Noninvasive molecular imaging of glioma tumor receptor activity was assessed with diagnostic in vivo fluorescence monitoring during targeted therapy. The study goals were to assess the range of use for treatment monitoring and stratification of tumor types using EGFR status with administration of fluorescently labeled epidermal growth factor (EGF), and determine its utility for tumor detection compared to magnetic resonance imaging (MRI).
Materials and Methods
Epidermal growth factor receptor positive and negative (EGFR+ and EGFR−) glioma tumor lines (U251-GFP and 9L-GFP, respectively) were used to assess these goals, having a 20-fold difference between their EGF uptakes.
Results
Treatment with cetuximab, in the EGFR+ tumor-bearing animals led to decreased EGF tumor uptake, whereas for the EGFR− tumors no change in fluorescence signal followed treatment. This diagnostic difference in EGFR expression could be used to stratify the tumor-bearing animals into groups of potential responders and non-responders, and receiver operator characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.92 in separating these tumors. The non-localized growth pattern of U251-GFP tumors resulted in detection difficulty via standard MRI, however high EGFR expression made them detectable through fluorescence imaging (ROC-AUC = 1.0). The EGFR+, U251-GFP tumor-bearing animals could be noninvasively stratified into treated and untreated groups based on fluorescence intensity difference (p = 0.035, ROC-AUC = 0.90).
Conclusions
EGFR expression was tracked in vivo with fluorescence, and determined to be of use for stratification of EGFR+ and EGFR− tumors, detection of EGFR+ tumors and monitoring of molecular therapy.