Evaluation of the apparent diffusion coefficient in patients with recurrent glioblastoma under treatment with bevacizumab with radiographic pseudoresponse

Auer, Timo Alexander; Breit, Hanns‐Christian; Marini, Fédérico; Renovanz, Mirjam; Ringel, Florian; Sommer, Clemens; Brockmann, Marc A.; Tanyildizi, Yasemin

doi:10.1016/j.neurad.2018.04.002

Cited by 16 publications

(13 citation statements)

References 47 publications

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“…Compared to previous studies, the present clinical study showed relatively satisfactory results and met our expectations. However, the good response data based on the results of MRI may be an effect of pseudo-response similar to what is known with bevacizumab 28. In our clinical study, patients who failed treatment with apatinib had particularly rapid tumor recurrence and more diffused cerebral edema.…”

Section: Discussionsupporting

confidence: 73%

<p>Apatinib Plus Temozolomide for Recurrent Glioblastoma: An Uncontrolled, Open-Label Study</p>

Wang¹,

Meng²,

Zhou³

et al. 2019

OTT

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ObjectiveThis study aimed to determine the efficacy and tolerability of apatinib plus dose-dense temozolomide (TMZ) as first-line treatment for recurrent glioblastoma (rGBM).MethodsPatients with rGBM were enrolled in this study. Patients were subjected to concurrent treatment of apatinib (500 mg qd) and dose-dense TMZ (100 mg/m2, 7 days on with 7 days off) until disease progression or intolerable toxicity. Efficacy was evaluated using Response Assessment in Neuro-Oncology criteria for high-grade glioma. Safety was assessed using NCI-CTCAE 4.0. Survival was estimated with Kaplan–Meier curve and log rank test.ResultsFrom March 2016 to January 2018, 20 eligible patients who had relapsed from the standard chemoradiotherapy regimen (TMZ and radiotherapy) were enrolled in this study. The median follow-up time was 12 months. All patients were eligible for efficacy analysis. The objective response rate (ORR) was 45%. The disease control rate (DCR) was 90%. The median progress-free survival time was 6 months (95% CI, 5.3 to 7.8 months). The 6-month progression-free survival rate was 50%. The median overall survival was 9 months (95% CI, 8.2 to 12.2 months). The most common treatment-related adverse events were hypertension (21%), hand–foot syndrome (16%), leukopenia (14%), and thrombocytopenia (12%).ConclusionApatinib combined with dose-dense TMZ was effective in terms of PFS, ORR, and DCR and was well tolerated after appropriate dose reduction in the Chinese population tested. Further randomized controlled clinical studies are needed to confirm the efficacy of apatinib combined with TMZ for treatment of rGBM.

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Section: Discussionsupporting

confidence: 73%

<p>Apatinib Plus Temozolomide for Recurrent Glioblastoma: An Uncontrolled, Open-Label Study</p>

Wang¹,

Meng²,

Zhou³

et al. 2019

OTT

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“…These diffusion changes suggest increased microstructural integrity, probably associated with vascular normalization resulting from BEV treatment. 21,29,61 More importantly, our study demonstrates that post-BEV DKI metrics may provide information about tumor progression. Higher post-BEV diffusivity (MD, D k , D k10% and D k90% ) and lower kurtosis (K k10% ) in NELs were correlated with poor PFS.…”

Section: Discussionmentioning

confidence: 69%

Early assessment of recurrent glioblastoma response to bevacizumab treatment by diffusional kurtosis imaging: a preliminary report

et al. 2019

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Purpose The purpose of this preliminary study is to apply diffusional kurtosis imaging to assess the early response of recurrent glioblastoma to bevacizumab treatment. Methods This prospective cohort study included 10 patients who had been diagnosed with recurrent glioblastoma and scheduled to receive bevacizumab treatment. Diffusional kurtosis images were obtained from all the patients 0–7 days before (pre-bevacizumab) and 28 days after (post-bevacizumab) initiating bevacizumab treatment. The mean, 10th, and 90th percentile values were derived from the histogram of diffusional kurtosis imaging metrics in enhancing and non-enhancing lesions, selected on post-contrast T1-weighted and fluid-attenuated inversion recovery images. Correlations of imaging measures with progression-free survival and overall survival were evaluated using Spearman's rank correlation coefficient. The significance level was set at P < 0.05. Results Higher pre-bevacizumab non-enhancing lesion volume was correlated with poor overall survival ( r = −0.65, P = 0.049). Higher post-bevacizumab mean diffusivity and axial diffusivity (D∥, D∥10% and D∥90%) in non-enhancing lesions were correlated with poor progression-free survival ( r = −0.73, −0.83, −0.71 and −0.85; P < 0.05). Lower post-bevacizumab axial kurtosis (K∥10%) in non-enhancing lesions was correlated with poor progression-free survival ( r = 0.81, P = 0.008). Conclusions This preliminary study demonstrates that diffusional kurtosis imaging metrics allow the detection of tissue changes 28 days after initiating bevacizumab treatment and that they may provide information about tumor progression.

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“…However, the post-regorafenib variation in the mean ADC thus calculated did not signi cantly correlate with the corresponding change in FET-positive volume, nor with the RANO response categories. A possible explanation for this discrepancy may lie in the different methodological approaches used here and in the previously published studies [13,34,[43][44][45][35][36][37][38][39][40][41][42]. This highlights the importance of future efforts towards standardizing the analysis of ADC maps before considering the inclusion of this methodology in the response assessment criteria.…”

Section: Discussionmentioning

confidence: 82%

“…A standard spherical volume (radius = 5 mm) was then placed on the ADC images in the hemisphere contralateral to the tumor, carefully avoiding lateral ventricles and major vessels, in order to derive the mean ADC value of the normal brain parenchyma (BG ADC ). This method was chosen in view of the stability of the ADC values in the "healthy" brain parenchyma during treatment with antiangiogenetic agents [13]. A qualitative assessment of the high resolution DWI and ADC derived maps was performed in every patient and revealed no signi cant distortions or misregistrations affecting the selected tumor area or background area.…”

Section: Page 4/11mentioning

confidence: 99%

Preliminary results using PET/MR in glioblastoma patients treated with regorafenib: an 18F-FET and DWI-ADC comparison

Spimpolo

Lombardi

Berti

et al. 2021

Preprint

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Introduction: The use of regorafenib in recurrent glioblastoma patients has been recently approved by the Italian Medicines Agency (AIFA) and added to the National Comprehensive Cancer Network (NCCN) 2020 guidelines as a preferred regimen. Given its complex effects at the molecular level, the most appropriate imaging tools to assess early response to treatment is still a matter of debate. DWI and 18F–FET PET are promising methodologies providing additional information to the currently used RANO criteria. The aim of this study was to evaluate the variations in DWI/ADC- and 18F-FET PET-derived parameters in patients who underwent PET/MR at both baseline and soon after starting regorafenib. Method: We retrospectively selected 16 consecutive GBM patients who underwent 18F–FET PET/MR before and after two cycles of regorafenib. Patients were sorted into stable (SD) or progressive disease (PD) categories in accordance with RANO criteria. We were also able to analyze 4 SD patients who underwent a third PET/MR after another 4 cycles of regorafenib. 18F–FET uptake greater than 1.6 times the mean background activity was used to define an area to be superimposed on an ADC map at baseline and soon after treatment. A number of metrics were then derived and compared. Result: The average increases in FET and ADC pathological volumes were higher in PD than in SD patients, although in neither case did the difference reach significance. However, when the percentage difference in FET volumes was plotted against the corresponding percentage difference in ADC, a correlation was observed (R = 0.54). Patients with a twofold increase in FET after regorafenib showed a significantly higher increase in ADC pathological volume than the remaining subjects (p = 0.0023). Conclusion: In recurrent glioblastoma patients treated with regorafenib, 18F-FET and ADC metrics, being obtained from completely different measures, could serve as semi-quantitative independent biomarkers of response to treatment. These promising parameters should be tested in a larger cohort of glioblastoma patients treated with regorafenib.

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Evaluation of the apparent diffusion coefficient in patients with recurrent glioblastoma under treatment with bevacizumab with radiographic pseudoresponse

Cited by 16 publications

References 47 publications

<p>Apatinib Plus Temozolomide for Recurrent Glioblastoma: An Uncontrolled, Open-Label Study</p>

<p>Apatinib Plus Temozolomide for Recurrent Glioblastoma: An Uncontrolled, Open-Label Study</p>

Early assessment of recurrent glioblastoma response to bevacizumab treatment by diffusional kurtosis imaging: a preliminary report

Preliminary results using PET/MR in glioblastoma patients treated with regorafenib: an 18F-FET and DWI-ADC comparison

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