Quantitative Imaging in Cancer Clinical Trials

Abstract

As anti-cancer therapies designed to target specific molecular pathways have been developed, it has become critical to develop methods to assess the response induced by such agents. While traditional, anatomic CT and MRI exams are useful in many settings, there is increasing evidence that these methods cannot answer the fundamental biological and physiological questions essential for assessment and, eventually, prediction of treatment response in the clinical trial setting, especially in the critical period soon after treatment is initiated. To optimally apply advances in quantitative imaging methods to trials of targeted cancer therapy, new infrastructure improvements are needed that incorporate these emerging techniques into the settings where they are most likely to have impact. In this review, we first elucidate the needs for therapeutic response assessment in the era of molecularly targeted therapy and describe how quantitative imaging can most effectively provide scientifically and clinically relevant data. We then describe the tools and methods required to apply quantitative imaging and provide concrete examples of work making these advances practically available for routine application in clinical trials. We conclude by proposing strategies to surmount barriers to wider incorporation of these quantitative imaging methods into clinical trials and, eventually, clinical practice. Our goal is to encourage and guide the oncology community to deploy standardized quantitative imaging techniques in clinical trials to further personalize care for cancer patients, and to provide a more efficient path for the development of improved targeted therapies.

Imaging Considerations and Interprofessional Opportunities in the Care of Breast Cancer Patients in the Neoadjuvant Setting

“…45,69 One limitation of the quantitative MRI techniques currently available is that there are no multi-site, multi-vendor studies presently validating them. 27 …”

“…The Quantitative Imaging Network (QIN) is striving to address these limitations by standardizing methods for all imaging modalities for image acquisition, analysis, and data sharing in order for these methods to be implemented in multi-site trials. 27,115 Additionally, the Quantitative Imaging Biomarkers Alliance (QIBA), organized by the Radiological Society of North America, is seeking to improve the value and practicality of quantitative imaging biomarkers of quantifiable features from medical imaging, by reducing variability across devices and patients in order to assess disease status or degrees of change over time. 116 These initiatives seek to create collaborations in order to identify the needs, barriers, and solutions to create consistent and reliable imaging results across a multitude of imaging platforms and sites.…”

An Assessment of Imaging Informatics for Precision Medicine in Cancer

“…Imaging, which includes radiology, radiation oncology, and pathology, complements clinical and molecular data and offers crucial insights that help stratify patients into cohorts and guide care using the principles of precision medicine [3][4][5][6][7]. In addition to diagnosis and treatment planning, imaging also has the potential to provide deep and novel insights by evaluating a patient's response to therapy during treatment, as well as predicting outcome at an earlier time point [6][7][8].…”

The promise of multiparametric imaging in oncology: how do we move forward?

“…For PET [6] and also MRI [7], standardization (or harmonization) procedures are currently in place or being developed. These procedures should remove some of the uncertainties and difficulties that multicentre trials face in quantitative analysis and allow more robust quantitative imaging-derived parameters [8].…”