TY - JOUR
T1 - MR spectroscopic imaging predicts early response to anti-angiogenic therapy in recurrent glioblastoma
AU - Talati, Pratik
AU - El-Abtah, Mohamed
AU - Kim, Daniel
AU - Dietrich, Jorg
AU - Fu, Melanie
AU - Wenke, Michael
AU - He, Julian
AU - Natheir, Sharif N.
AU - Vangel, Mark
AU - Rapalino, Otto
AU - Vaynrub, Anna
AU - Arrillaga-Romany, Isabel
AU - Forst, Deborah A.
AU - Yen, Yi Fen
AU - Andronesi, Ovidiu
AU - Kalpathy-Cramer, Jayashree
AU - Rosen, Bruce
AU - Batchelor, Tracy T.
AU - Gonzalez, R. Gilberto
AU - Gerstner, Elizabeth R.
AU - Ratai, Eva Maria
N1 - Publisher Copyright:
© The Author(s) 2021.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Background. Determining failure to anti-angiogenic therapy in recurrent glioblastoma (GBM) (rGBM) remains a challenge. The purpose of the study was to assess treatment response to bevacizumab-based therapy in patients with rGBM using MR spectroscopy (MRS). Methods. We performed longitudinal MRI/MRS in 33 patients with rGBM to investigate whether changes in N-acetylaspartate (NAA)/Choline (Cho) and Lactate (Lac)/NAA from baseline to subsequent time points after treatment can predict early failures to bevacizumab-based therapies. Results. After stratifying based on 9-month survival, longer-term survivors had increased NAA/Cho and decreased Lac/NAA levels compared to shorter-term survivors. ROC analyses for intratumoral NAA/Cho correlated with survival at 1 day, 2 weeks, 8 weeks, and 16 weeks. Intratumoral Lac/NAA ROC analyses were predictive of survival at all time points tested. At the 8-week time point, 88% of patients with decreased NAA/Cho did not survive 9 months; furthermore, 90% of individuals with an increased Lac/NAA from baseline did not survive at 9 months. No other metabolic ratios tested significantly predicted survival. Conclusions. Changes in metabolic levels of tumoral NAA/Cho and Lac/NAA can serve as early biomarkers for predicting treatment failure to anti-angiogenic therapy as soon as 1 day after bevacizumab-based therapy. The addition of MRS to conventional MR methods can provide better insight into how anti-angiogenic therapy affects tumor microenvironment and predict patient outcomes.
AB - Background. Determining failure to anti-angiogenic therapy in recurrent glioblastoma (GBM) (rGBM) remains a challenge. The purpose of the study was to assess treatment response to bevacizumab-based therapy in patients with rGBM using MR spectroscopy (MRS). Methods. We performed longitudinal MRI/MRS in 33 patients with rGBM to investigate whether changes in N-acetylaspartate (NAA)/Choline (Cho) and Lactate (Lac)/NAA from baseline to subsequent time points after treatment can predict early failures to bevacizumab-based therapies. Results. After stratifying based on 9-month survival, longer-term survivors had increased NAA/Cho and decreased Lac/NAA levels compared to shorter-term survivors. ROC analyses for intratumoral NAA/Cho correlated with survival at 1 day, 2 weeks, 8 weeks, and 16 weeks. Intratumoral Lac/NAA ROC analyses were predictive of survival at all time points tested. At the 8-week time point, 88% of patients with decreased NAA/Cho did not survive 9 months; furthermore, 90% of individuals with an increased Lac/NAA from baseline did not survive at 9 months. No other metabolic ratios tested significantly predicted survival. Conclusions. Changes in metabolic levels of tumoral NAA/Cho and Lac/NAA can serve as early biomarkers for predicting treatment failure to anti-angiogenic therapy as soon as 1 day after bevacizumab-based therapy. The addition of MRS to conventional MR methods can provide better insight into how anti-angiogenic therapy affects tumor microenvironment and predict patient outcomes.
UR - https://www.scopus.com/pages/publications/85124160376
UR - https://www.scopus.com/inward/citedby.url?scp=85124160376&partnerID=8YFLogxK
U2 - 10.1093/noajnl/vdab060
DO - 10.1093/noajnl/vdab060
M3 - Article
AN - SCOPUS:85124160376
SN - 2632-2498
VL - 3
JO - Neuro-Oncology Advances
JF - Neuro-Oncology Advances
IS - 1
M1 - vdab060
ER -