MRI Measurements of Breast Tumor Volume Predict Response to Neoadjuvant Chemotherapy and Recurrence-Free Survival

Partridge, Savannah C.; Gibbs, Jessica; Lü, Ying; Esserman, Laura J.; Tripathy, Debasish; Wolverton, Dulcy; Rugo, Hope S.; Hwang, E. Shelley; Ewing, Cheryl A.; Hylton, Nola M.

doi:10.2214/ajr.184.6.01841774

Cited by 248 publications

(190 citation statements)

References 32 publications

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“…Although this reduction may appear dramatic, it is fully consistent with the results reported by Nonaka et al (2012), who observed a 97% volume reduction of human hepatocellular carcinoma after 3 weeks of subcutaneous injection with GcMAF. It is also consistent with the results reported for neoadjuvant chemotherapy (Partridge et al, 2005).…”

Section: Resultssupporting

confidence: 93%

Clinical Experience of Cancer Immunotherapy Integrated With Oleic Acid Complexed With De-Glycosylated Vitamin D Binding Protein

Ward¹,

Smith²,

Noakes

et al. 2014

American Journal of Immunology

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Proteins highly represented in milk such as α-lactalbumin and lactoferrin bind Oleic Acid (OA) to form complexes with selective anti-tumor activity. A protein present in milk, colostrum and blood, vitamin D binding protein is the precursor of a potent Macrophage Activating Factor (GcMAF) and in analogy with other OA-protein complexes, we proposed that OA-GcMAF could demonstrate a greater immunotherapeutic activity than that of GcMAF alone. We describe a preliminary experience treating patients with advanced cancers, often labelled as "incurable" with an integrative immunotherapy centred on OA-GcMAF. Patients with advanced cancer were treated at the Immuno Biotech Treatment Centre with OA-GcMAF-based integrative immunotherapy in combination with a very low carbohydrate, high protein diet, fermented milk products containing naturally produced GcMAF, vitamin D 3 and low-dose acetylsalicylic acid. When the primary tumor or a metastasis could be measured by ultrasonographic techniques, we observed, on average, a decrease of tumor volume of approximately 25% in a week. We also observed a consistent increase in splenic blood flow that was interpreted in the context of generalised immune system activation and allowed to assess the degree of responsiveness of the individual patient. The results reported here are consistent with the results previously described in the experimental animal harbouring a human hepatocellular carcinoma as well as with the results reported for neoadjuvant chemotherapy. OA-protein complexes are bound to play a leading role in cancer therapy thanks to selectivity of antitumoral effects, absence of any side effects, safety and oral availability. We hypothesise that OA-GcMAF, combines the known anticancer effects OA-protein complexes with the well established immune stimulating effects of GcMAF.

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Section: Resultssupporting

confidence: 93%

Clinical Experience of Cancer Immunotherapy Integrated With Oleic Acid Complexed With De-Glycosylated Vitamin D Binding Protein

Ward¹,

Smith²,

Noakes

et al. 2014

American Journal of Immunology

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“…Tumour volumes were measured, rather than more typical linear measurements, as this was considered to be the most rigorous and accurate, although most time-consuming, way of quantifying lesion size. Tumour volume has been shown to correlate more closely than tumour diameter with disease-free survival in breast cancer patients and it may also provide a more sensitive characterisation of tumour response than one-dimensional measurements (Partridge et al, 2005).…”

Section: Mr Imaging and Spectroscopymentioning

confidence: 99%

Neoadjuvant chemotherapy in breast cancer: early response prediction with quantitative MR imaging and spectroscopy

et al. 2006

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A prospective study was undertaken in women undergoing neoadjuvant chemotherapy for locally advanced breast cancer in order to determine the ability of quantitative magnetic resonance imaging (MRI) and proton spectroscopy (MRS) to predict ultimate tumour response (percentage decrease in volume) or to detect early response. Magnetic resonance imaging and MRS were carried out before treatment and after the second of six treatment cycles. Pharmacokinetic parameters were derived from T 1 -weighted dynamic contrast-enhanced MRI, water apparent diffusion coefficient (ADC) was measured, and tissue water : fat peak area ratios and water T 2 were measured using unsuppressed one-dimensional proton spectroscopic imaging (30 and 135 ms echo times). Pharmacokinetic parameters and ADC did not detect early response; however, early changes in water : fat ratios and water T 2 (after cycle two) demonstrated substantial prognostic efficacy. Larger decreases in water T 2 accurately predicted final volume response in 69% of cases (11/16) while maintaining 100% specificity and positive predictive value. Small/absent decreases in water : fat ratios accurately predicted final volume non-response in 50% of cases (3/6) while maintaining 100% sensitivity and negative predictive value. This level of accuracy might permit clinical application where early, accurate prediction of non-response would permit an early change to second-line treatment, thus sparing patients unnecessary toxicity, psychological morbidity and delay of initiation of effective treatment.

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“…However, they also found that patients achieving both clinical and ultrasound complete responses, and not undergoing surgery, had a low (8%) rate of locoregional recurrence at 5 years. Additionally, MRI has also proven to be useful in the assessment of the tumour response to chemotherapy (Thibault et al, 2004;Warren et al, 2004;Partridge et al, 2005;Segara et al, 2007). This good value of MRI in the evaluation of tumour response should also apply to ILC as, even though ILC is still a challenge for MRI (Kinkel and Hylton, 2001), the addition of MRI to mammography still increases the sensitivity in the detection of ILC (Gilles et al, 1994;Sittek et al, 1998) and, most importantly in the case of the response evaluation, the volumetric assessment is improved (Boetes et al, 2004;Fabre Demard et al, 2005;Caramella et al, 2007;Mann et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

et al. 2008

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The literature reports low rates of breast conservation after neoadjuvant chemotherapy for operable breast cancers not amenable to initial breast-conserving surgery. This study aims to compare the outcome of lobular vs ductal carcinomas after neoadjuvant chemotherapy. Between 1989 and 1999, 750 patients with clinical stage II/IIIA ductal (672) or lobular (78) invasive breast carcinomas were treated at the Institut Curie with primary anthracycline-based polychemotherapy followed by either breast conservation (surgery and/or radiotherapy) or mastectomy. Median follow-up was 10 years. Clinical response to primary chemotherapy was significantly worse for lobular than for ductal carcinomas (47 vs 60%; P ¼ 0.04), but only histological grade remained predictive in multivariate analysis. Breast conservation was high for both ductal and lobular carcinomas (65 and 54%; P ¼ 0.07), due, in part, to the use of radiotherapy, either exclusive or preoperative, for respectively 26 and 40% of patients. The lobular type had no adverse effect, neither on locoregional control nor on overall survival, even in the group of patients treated with breast conservation.

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MRI Measurements of Breast Tumor Volume Predict Response to Neoadjuvant Chemotherapy and Recurrence-Free Survival

Abstract: MRI tumor volume was more predictive of RFS than tumor diameter, suggesting that volumetric changes measured using MRI may provide a more sensitive assessment of treatment efficacy.

Cited by 248 publications

References 32 publications

Clinical Experience of Cancer Immunotherapy Integrated With Oleic Acid Complexed With De-Glycosylated Vitamin D Binding Protein

Clinical Experience of Cancer Immunotherapy Integrated With Oleic Acid Complexed With De-Glycosylated Vitamin D Binding Protein

Neoadjuvant chemotherapy in breast cancer: early response prediction with quantitative MR imaging and spectroscopy

High rates of breast conservation for large ductal and lobular invasive carcinomas combining multimodality strategies

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