Serial MRI/MRSI of Patients with Gliomas Being Treated with Novel Therapies
- Author(s): Yeh, Alex
- Advisor(s): Nelson, Sarah
- et al.
Background: Glioblastoma multiforme (GBM) is a primary brain tumor that typically results in poor outcomes. A number of combination therapies are being considered for improving the prognosis for such patients. In this study serial MRI data were evaluated from patients with newly diagnosed GBM who were participating in a single-arm, Phase II clinical trial for an autologous heat-shock protein peptide complex-96 (HSPPC-96) vaccine.
Methods: Patients underwent surgical resection, radiation with temozolomide, and concurrent administrations of heat-shock protein peptide complex-96 (HSPPC-96) vaccine and temozolomide. Anatomical, diffusion-weighted, and perfusion-weighted imaging parameters were examined starting after radiation therapy/temozolomide and before the first vaccine administration. Patients were imaged at regular time points thereafter. Imaging parameters were assessed for changes from baseline and for their association with overall survival (OS) and progression-free survival (PFS) using a Cox proportional hazards model.
Results: Starting at 200 days after the completion of radiotherapy, significant increases from baseline were consistently seen in both 10th percentile of the normalized apparent diffusion coefficient (nADC) and the median nADC values in the T2 hyperintense lesion. At 250-350 days from baseline, significant associations were seen for nADC values with both PFS and OS.
Conclusion: Multiparametric MR imaging provides a non-invasive method to elucidate more information about how the tumor is responding to combination therapies that include adding a novel immunotherapy vaccine to standard of care radiation and temozolomide.