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Evaluation of Biomarkers in Glioma by Immunohistochemistry on Paraffin-Embedded 3D Glioma Neurosphere Cultures
Published on: January 9, 2019
Response criteria for glioma
A Gregory Sorensen1, Tracy T Batchelor, Patrick Y Wen
1Harvard Medical School, Boston, MA, USA. sorensen@nmr.mgh.harvard.edu
Nature Clinical Practice. Oncology
|August 20, 2008
Summary
Current glial tumor therapy assessment relies on outdated methods. We propose volumetric assessment and mechanistic imaging to improve accuracy and avoid overestimating drug benefits in clinical trials.
Area of Science:
- Neuro-oncology
- Medical Imaging
- Clinical Trial Design
Background:
- The Macdonald criteria (1990) for assessing glial tumor therapy response use cross-sectional imaging and clinical factors.
- These criteria have limitations, including the inaccuracy of cross-sectional vs. volumetric measurements and difficulty distinguishing antitumor effects from blood-brain barrier changes.
- Insufficient response criteria may lead to overestimation of drug efficacy in early trials, causing later-stage trial failures.
Purpose of the Study:
- To highlight the limitations of current glial tumor response assessment methods.
- To propose improved criteria for evaluating therapy response in glial tumors.
- To enhance the reliability of early-phase drug studies for brain tumors.
Main Methods:
- Review of existing glial tumor response assessment criteria.
- Comparison of cross-sectional versus volumetric imaging techniques.
- Discussion of the role of mechanistic imaging and blood biomarkers.
- Analysis of potential biases in current response evaluation.
Main Results:
- Current cross-sectional imaging is less accurate than feasible volumetric assessment for measuring glial tumor size.
- Distinguishing direct antitumor effects from therapy-induced blood-brain barrier changes is challenging.
- Existing criteria may overestimate treatment benefits, leading to premature advancement of ineffective therapies.
- Reporting both radiographic and clinical response rates is recommended.
Conclusions:
- Volumetric assessment should replace cross-sectional measurements for glial tumors.
- Mechanistic imaging and blood biomarkers should be integrated more frequently into study designs.
- Investigators must acknowledge the limitations of imaging biomarkers as surrogate endpoints.
- Revised assessment strategies will improve the accuracy of drug efficacy evaluation in neuro-oncology.
