Promise and pitfalls of quantitative imaging in oncology clinical trials
Brenda F Kurland1, Elizabeth R Gerstner, James M Mountz
1Fred Hutchinson Cancer Research Center, Seattle, WA 98019, USA. bkurland@fhcrc.org
Abstract:
Quantitative imaging using computed tomography, magnetic resonance imaging and positron emission tomography modalities will play an increasingly important role in the design of oncology trials addressing molecularly targeted, personalized therapies. The advent of molecularly targeted therapies, exemplified by antiangiogenic drugs, creates new complexities in the assessment of response. The Quantitative Imaging Network addresses the need for imaging modalities which can accurately and reproducibly measure not just change in tumor size but changes in relevant metabolic parameters, modulation of relevant signaling pathways, drug delivery to tumor and differentiation of apoptotic cell death from other changes in tumor volume. This article provides an overview of the applications of quantitative imaging to phase 0 through phase 3 oncology trials. We describe the use of a range of quantitative imaging modalities in specific tumor types including malignant gliomas, lung cancer, head and neck cancer, lymphoma, breast cancer, prostate cancer and sarcoma. In the concluding section, we discuss potential constraints on clinical trials using quantitative imaging, including complexity of trial conduct, impact on subject recruitment, incremental costs and institutional barriers. Strategies for overcoming these constraints are presented.
Insights
Quantitative imaging is crucial for oncology trials with targeted therapies, assessing more than tumor size. This approach enhances response evaluation in personalized cancer treatment.
Area of Science:
- Radiology and Oncology
- Medical Imaging
- Clinical Trial Design
Background:
- Molecularly targeted therapies, like antiangiogenic drugs, introduce complexities in assessing treatment response.
- Traditional tumor size measurements are insufficient for evaluating the efficacy of novel cancer therapies.
- There is a need for advanced imaging techniques to accurately measure treatment effects beyond tumor volume.
Purpose of the Study:
- To provide an overview of quantitative imaging applications in oncology clinical trials (Phase 0-III).
- To highlight the role of quantitative imaging in evaluating molecularly targeted and personalized therapies.
- To discuss the use of various imaging modalities for assessing treatment response in specific cancer types.
Main Methods:
- Review of quantitative imaging applications across Phase 0-III oncology trials.
- Description of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) in cancer research.
- Case examples of quantitative imaging in malignant gliomas, lung cancer, head and neck cancer, lymphoma, breast cancer, prostate cancer, and sarcoma.
Main Results:
- Quantitative imaging enables measurement of metabolic parameters, pathway modulation, drug delivery, and cell death.
- Demonstrates the utility of quantitative imaging in assessing response to targeted therapies.
- Provides a comprehensive overview of modality use in diverse oncological settings.
Conclusions:
- Quantitative imaging is essential for accurate and reproducible assessment in modern oncology trials.
- Addressing challenges like trial complexity, recruitment, cost, and institutional barriers is key to wider adoption.
- Quantitative imaging offers a robust framework for evaluating personalized cancer therapies.
