Intravoxel incoherent motion magnetic resonance imaging for predicting the long-term efficacy of immune checkpoint inhibitors in patients with non-small-cell lung cancer. (May 2020)

• Record Type: Journal Article
• Authors: Karayama, Masato; Yoshizawa, Nobuko; Sugiyama, Masataka; Mori, Kazutaka; Yasui, Hideki; Hozumi, Hironao; Suzuki, Yuzo; Furuhashi, Kazuki; Fujisawa, Tomoyuki; Enomoto, Noriyuki; Nakamura, Yutaro; Inui, Naoki; Goshima, Satoshi; Suda, Takafumi; Takehara, Yasuo
• Is Part Of: Lung cancer. Volume 143(2020)
• Page Start: 47
• Page End: 54
• Publication Date: 2020-05
• Subjects: ADC apparent diffusion coefficient -- ADCkurt kurtosis of ADC -- ADCskew skewness of ADC -- AUC area under the curve -- CI confident interval -- DWI-MRI diffusion-weighted magnetic resonance imaging -- ECOG Eastern Cooperative Oncology Group -- ICI immune checkpoint inhibitor -- IVIM-MRI intravoxel incoherent motion magnetic resonance imaging -- MRI magnetic resonance imaging -- NSCLC non-small-cell lung cancer -- OS overall survival -- PD progressive disease -- PD-1 programmed death-1 -- PD-L1 programmed death ligand-1 -- PFS progression-free survival -- PR partial response -- RECIST Response Evaluation Criteria in Solid Tumors -- ROC receiver operating characteristic -- ROI region of interest -- SD stable disease -- TPS tumor proportion score -- TTR time to response -- D true diffusion coefficient -- D* pseudodiffusion coefficient -- f perfusion fraction -- Δ change from the baseline; IVIM-MRI -- Immune therapy -- Anti-programmed death-1 therapy -- Anti-PD-1 therapy -- Pseudoprogression -- Atypical radiologic response; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.03.013
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Tumor size is insufficient for evaluating responses to immune checkpoint inhibitors. MRI provides qualitative information about the tumor microenvironment. Changes in histograms of apparent diffusion coefficient correlate with efficacy. Histograms of apparent diffusion coefficient change in pseudoprogression. Abstract: Objectives: Conventional evaluation of anti-tumor activity on the basis of tumor size is inadequate for immune checkpoint inhibitors (ICIs). We therefore aimed to assess the usefulness of intravoxel incoherent motion magnetic resonance imaging (IVIM-MRI) for evaluation of the therapeutic efficacy of ICIs. Materials and methods: A chest IVIM-MRI was performed before and 2, 4, and 8 weeks after administration of ICIs in patients with advanced non-small-cell lung cancer. Apparent diffusion coefficient (ADC), skewness of ADC (ADCskew ), kurtosis of ADC (ADCkurt ), true diffusion coefficient ( D ), pseudodiffusion coefficient ( D* ), and perfusion fraction ( f ) were evaluated at each evaluation point and changes from the baseline (Δ). Results: Twenty patients were enrolled in this study. An increased ADC 8 weeks and decreased ADCkurt and ΔADCkurt 4 weeks after ICIs was associated with objective responses and longer progression-free survival (PFS). A decreased ΔADCskew at 4 weeks was associated with objective responses, disease control, and longer PFS and overall survival. There was no correlation between the efficacy of ICIs and D, D* and f . All of three patients who had pseudoprogression had decreased ΔADCskew at 4 weeks and two of them had decreased ΔADCkurt at 4 weeks. Inversely, all five patients who had progressive disease (PD) did not have increased ΔADCskew at 4 weeks and only one of them had decreased ΔADCkurt at 4 weeks. Conclusions: Changes in histograms of ADC may be useful for predicting long-term efficacy and distinguishing between pseudoprogression and actual PD after ICIs.