Diffusion-Weighted MRI for Predicting Pathologic Complete Response in Neoadjuvant Immunotherapy

Wen Li; Nu N. Le; Natsuko Onishi; David C. Newitt; Lisa J. Wilmes; Jessica E. Gibbs; Julia Carmona-Bozo; Jiachao Liang; Savannah C. Partridge; Elissa R. Price; Bonnie N. Joe; John Kornak; Mark Jesus M. Magbanua; Rita Nanda; Barbara LeStage; Laura J. Esserman; I-SPY Imaging Working Group; I-SPY Investigator Network; Laura J. van’t Veer; Nola M. Hylton

doi:10.3390/cancers14184436

Cancers (Sep 2022)

Diffusion-Weighted MRI for Predicting Pathologic Complete Response in Neoadjuvant Immunotherapy

Wen Li,
Nu N. Le,
Natsuko Onishi,
David C. Newitt,
Lisa J. Wilmes,
Jessica E. Gibbs,
Julia Carmona-Bozo,
Jiachao Liang,
Savannah C. Partridge,
Elissa R. Price,
Bonnie N. Joe,
John Kornak,
Mark Jesus M. Magbanua,
Rita Nanda,
Barbara LeStage,
Laura J. Esserman,
I-SPY Imaging Working Group,
I-SPY Investigator Network,
Laura J. van’t Veer,
Nola M. Hylton

Affiliations

Wen Li: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA
Nu N. Le: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA
Natsuko Onishi: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA
David C. Newitt: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA
Lisa J. Wilmes: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA
Jessica E. Gibbs: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA
Julia Carmona-Bozo: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA
Jiachao Liang: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA
Savannah C. Partridge: Department of Radiology, University of Washington, 1100 Fairview Ave N, Seattle, Washington, DC 98109, USA
Elissa R. Price: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA
Bonnie N. Joe: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA
John Kornak: Department of Epidemiology and Biostatistics, University of California, 550 16th Street, San Francisco, CA 94158, USA
Mark Jesus M. Magbanua: Department of Laboratory Medicine, University of California, 2340 Sutter Street, San Francisco, CA 94115, USA
Rita Nanda: Department of Medicine, University of Chicago, Chicago, IL 60637, USA
Barbara LeStage: I-SPY 2 Advocacy Group, 499 Illinois Street, San Francisco, CA 94158, USA
Laura J. Esserman: Department of Surgery, University of California, 550 16th Street, San Francisco, CA 94158, USA
I-SPY Imaging Working Group: Department of Radiology, University of Washington, 1100 Fairview Ave N, Seattle, Washington, DC 98109, USA
I-SPY Investigator Network: Department of Radiology, University of Washington, 1100 Fairview Ave N, Seattle, Washington, DC 98109, USA
Laura J. van’t Veer: Department of Laboratory Medicine, University of California, 2340 Sutter Street, San Francisco, CA 94115, USA
Nola M. Hylton: Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA

DOI: https://doi.org/10.3390/cancers14184436
Journal volume & issue: Vol. 14, no. 18
p. 4436

Abstract

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This study tested the hypothesis that a change in the apparent diffusion coefficient (ADC) measured in diffusion-weighted MRI (DWI) is an independent imaging marker, and ADC performs better than functional tumor volume (FTV) for assessing treatment response in patients with locally advanced breast cancer receiving neoadjuvant immunotherapy. A total of 249 patients were randomized to standard neoadjuvant chemotherapy with pembrolizumab (pembro) or without pembrolizumab (control). DCE-MRI and DWI, performed prior to and 3 weeks after the start of treatment, were analyzed. Percent changes of tumor ADC metrics (mean, 5th to 95th percentiles of ADC histogram) and FTV were evaluated for the prediction of pathologic complete response (pCR) using a logistic regression model. The area under the ROC curve (AUC) estimated for the percent change in mean ADC was higher in the pembro cohort (0.73, 95% confidence interval [CI]: 0.52 to 0.93) than in the control cohort (0.63, 95% CI: 0.43 to 0.83). In the control cohort, the percent change of the 95th percentile ADC achieved the highest AUC, 0.69 (95% CI: 0.52 to 0.85). In the pembro cohort, the percent change of the 25th percentile ADC achieved the highest AUC, 0.75 (95% CI: 0.55 to 0.95). AUCs estimated for percent change of FTV were 0.61 (95% CI: 0.39 to 0.83) and 0.66 (95% CI: 0.47 to 0.85) for the pembro and control cohorts, respectively. Tumor ADC may perform better than FTV to predict pCR at an early treatment time-point during neoadjuvant immunotherapy.

Published in Cancers

ISSN: 2072-6694 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.mdpi.com/journal/cancers/

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