Assessment of tumor hypoxia and perfusion in recurrent glioblastoma following bevacizumab failure using MRI and 18F-FMISO PET. Sci Rep 2021 Apr 07;11(1):7632
Date
04/09/2021Pubmed ID
33828310Pubmed Central ID
PMC8027395DOI
10.1038/s41598-021-84331-5Scopus ID
2-s2.0-85104042152 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
Tumoral hypoxia correlates with worse outcomes in glioblastoma (GBM). While bevacizumab is routinely used to treat recurrent GBM, it may exacerbate hypoxia. Evofosfamide is a hypoxia-targeting prodrug being tested for recurrent GBM. To characterize resistance to bevacizumab and identify those with recurrent GBM who may benefit from evofosfamide, we ascertained MRI features and hypoxia in patients with GBM progression receiving both agents. Thirty-three patients with recurrent GBM refractory to bevacizumab were enrolled. Patients underwent MR and 18F-FMISO PET imaging at baseline and 28 days. Tumor volumes were determined, MRI and 18F-FMISO PET-derived parameters calculated, and Spearman correlations between parameters assessed. Progression-free survival decreased significantly with hypoxic volume [hazard ratio (HR) = 1.67, 95% confidence interval (CI) 1.14 to 2.46, P = 0.009] and increased significantly with time to the maximum value of the residue (Tmax) (HR = 0.54, 95% CI 0.34 to 0.88, P = 0.01). Overall survival decreased significantly with hypoxic volume (HR = 1.71, 95% CI 1.12 to 12.61, p = 0.01), standardized relative cerebral blood volume (srCBV) (HR = 1.61, 95% CI 1.09 to 2.38, p = 0.02), and increased significantly with Tmax (HR = 0.31, 95% CI 0.15 to 0.62, p < 0.001). Decreases in hypoxic volume correlated with longer overall and progression-free survival, and increases correlated with shorter overall and progression-free survival. Hypoxic volume and volume ratio were positively correlated (rs = 0.77, P < 0.0001), as were hypoxia volume and T1 enhancing tumor volume (rs = 0.75, P < 0.0001). Hypoxia is a key biomarker in patients with bevacizumab-refractory GBM. Hypoxia and srCBV were inversely correlated with patient outcomes. These radiographic features may be useful in evaluating treatment and guiding treatment considerations.
Author List
Huang S, Michalek JE, Reardon DA, Wen PY, Floyd JR, Fox PT, Clarke GD, Jerabek PA, Schmainda KM, Muzi M, Hyun H, Lee EQ, Brenner AJAuthor
Kathleen M. Schmainda PhD Professor in the Biophysics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Bevacizumab
Biomarkers, Pharmacological
Brain Neoplasms
Cerebral Blood Volume
Drug Resistance, Neoplasm
Female
Glioblastoma
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Misonidazole
Neoplasm Recurrence, Local
Positron-Emission Tomography
Tumor Hypoxia
Young Adult