sophie taieb : selection of response criteria for clinical trials of cancer treatment :...
DESCRIPTION
TRANSCRIPT
![Page 1: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/1.jpg)
S o p h i e T a ï e b
C e n t r e O s c a r L a m b r e t
D é p a r t e m e n t d ’ I m a g e r i e
L i l l e - F r a n c e
F U N C T I O N A L A S P E C T C R I T E R I A
![Page 2: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/2.jpg)
• Critères Morphologiques • Taille Tumorale / Identification aux critères cliniques.
• Functional Criteria • Signal (TDM, IRM)
• Tumour Metabolism
• Vascularization
• Common language to same decisions • Reproducible criteria : Inter & Intra Observers.
• Objectif criteria = quantitative.
Comment ? How ?
![Page 3: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/3.jpg)
Functional Imaging
Technique Tumoral characteristics
MRI and CT and US Tumour volume
DCE-MRI, DCE-CT and DCE-US Vascularisation
DWI-MRI Cellular density
MRS Molecular component
TEP FDG Glucose Métabolism
TEP FES Hormonal Métabolism
![Page 4: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/4.jpg)
Increase of the signal after contrast administration
• DCE-IRM : Gadolinium chelates
• TDM : Iodine contrast
• US : Microbubbles
![Page 5: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/5.jpg)
Jain RK. Nature Medicine 2001;7:987-989
Anti-angiogéniques Anti-Vasculaire
![Page 6: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/6.jpg)
Dynamic acquisition after contrast administration (DOTAREM*)
![Page 7: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/7.jpg)
7
![Page 8: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/8.jpg)
CT emporal curves of contrast enhancement aorte / GG
LS Fournier , J Radiol 2007
![Page 9: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/9.jpg)
CHI-Q Software Quantification / ROI
Raw Data
Modelisation
![Page 10: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/10.jpg)
4
![Page 11: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/11.jpg)
Woman, 57-year-old. Bilateral renal cell. Pancreas metastasis / Sunitinib
![Page 12: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/12.jpg)
7
![Page 13: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/13.jpg)
Woman, 57-year-old. Bilateral renal cell. Pancreas metastasis / Sunitinib
![Page 14: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/14.jpg)
CT Baseline : 3 cm, HD : 67
D60: 3 cm, HD : 29.
SD with RECIST 1.1
RP with CHOI criteria.
M9 : CR
![Page 15: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/15.jpg)
Ø Peak intensity Ø Time to peak Ø Mean transit time Ø Slope of wash in Ø AUC, AUWI, AUWO.
flux F
veine artère
Volume V de tissus
![Page 16: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/16.jpg)
![Page 17: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/17.jpg)
![Page 18: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/18.jpg)
![Page 19: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/19.jpg)
![Page 20: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/20.jpg)
Artere Q
artere 1
Capillaire Q
cap 2
Kep
Ve
Interstitium Q
inter 3
Ktrans
Blood flow
k(0,2)
flux F
veine artère
Volume V de tissus
MRI and CT
![Page 21: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/21.jpg)
Analysis
Inte
nsit
é d
e s
ign
al
Temps
F
kep = Ktrans / Ve
Vp Ve
1. Perfusion (BF)
2. Blood volume
3. Permeability
4. Intersticiel volume
Ktrans
C.de Bazelaire – St Louis - Paris
![Page 22: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/22.jpg)
Temporal resolution : High - Seconde
All parameters
n Perfusion (BF)
n Blood volume
n Permeability
n Intersticiel volume
Inte
nsit
é d
e s
ign
al
Temps
( ) ( ) ( ) ( )∫∫ ⎟⎟⎠
⎞⎜⎜⎝
⎛−−
−+−=
t
e
trans
ptrans
pptis duutKuCKduutCFtC00
exp τν
τ
C.de Bazelaire – St Louis - Paris
![Page 23: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/23.jpg)
Only :
¨ Perfusion (BF)
¨ Blood volume
n Permeability
n Intersticiel vol Ktrans
Inte
nsit
é d
e s
ign
al
Temps
( ) ( ) ( )∫ ⎟⎟⎠
⎞⎜⎜⎝
⎛−
−=
t
e
trans
ptrans
tis duutKuCKtC0
expν
C.de Bazelaire – St Louis - Paris
Temporal resolution : low - mn
![Page 24: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/24.jpg)
Perfusion MRI
n Diagnosis value – K trans : Se 93%, Sp 96%
BL < DCIS < DIC
– Kep : BL < DCIS < DIC
– Fibroadenoma : K trans high with Kep low
Preim U et al. EJR 2011
Furman-Haran E et al. Cancer 2005
![Page 25: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/25.jpg)
Ø No Pre-treatment differences between responders and non-responders : Tumour diameter, volume, kinetic parameters.
§ Nor ADC (Woodhams R et al, Radiology 2010) – 398 pts § ADC useful (Li X et al. Med Oncol 2012) – 32 pts Before NAC
Mean ADC of responders lower than in non-resp. p<0,001
Ø Early response : ü Tumor diameter AUC [0.73-0.9] ü Kinetic parameters : Ktrans AUC [0.63-0.93] ü ADC : Useful but ADC cut off depends : B[800-1000],
multiB, 1.5 or 3 T.
![Page 26: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/26.jpg)
Perfusion MRI
n Pb tumoral heterogeneity
![Page 27: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/27.jpg)
![Page 28: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/28.jpg)
![Page 29: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/29.jpg)
98 patientes, > 1B1 : Corrélation avec CL, SSR, SG
![Page 30: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/30.jpg)
To morrow : multiparametric imaging
• Diagnosis • Treatment response
• Predictive before treatment
• Earlier : 1 or 2 cycles
+ TEP ?
![Page 31: Sophie Taieb : Selection of Response Criteria for Clinical Trials of Cancer Treatment : FUNCTIONAL ASPECT CRITERIA](https://reader033.vdocuments.net/reader033/viewer/2022052819/54559369b1af9f33608b48aa/html5/thumbnails/31.jpg)
Conclusion
• RECIST – En défaut • Respecter les contraintes lors Mesure
• Connaitre les dérives possibles
• Imagerie Fonctionnelle • Echo de contraste = Validée
• Perfusion IRM/TDM = à valider > 2 ans
• Diffusion, Spectroscopie = ??