MR spectroscopic imaging predicts early response to anti-angiogenic therapy in recurrent glioblastoma. Issue 1 (15th April 2021)

• Record Type: Journal Article
• Authors: Talati, Pratik; El-Abtah, Mohamed; Kim, Daniel; Dietrich, Jorg; Fu, Melanie; Wenke, Michael; He, Julian; Natheir, Sharif N; Vangel, Mark; Rapalino, Otto; Vaynrub, Anna; Arrillaga-Romany, Isabel; Forst, Deborah A; Yen, Yi-Fen; Andronesi, Ovidiu; Kalpathy-Cramer, Jayashree; Rosen, Bruce; Batchelor, Tracy T; Gonzalez, R Gilberto; Gerstner, Elizabeth R; Ratai, Eva-Maria
• Is Part Of: Neuro-oncology advances. Volume 3:Issue 1(2021)
• Publication Date: 2021-04-15
• Subjects: bevacizumab -- biomarker -- brain tumor -- lactate -- MR spectroscopy; 616.99481
• DOI: 10.1093/noajnl/vdab060
• Languages: English
• ISSNs: 2632-2498

Abstract

Abstract: 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.