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Diffusion-Weighted MRI for Predicting Pathologic Complete Response in Neoadjuvant Immunotherapy.

Wen Li¹, Nu N Le¹, Natsuko Onishi¹

¹Department of Radiology and Biomedical Imaging, University of California, 550 16th Street, San Francisco, CA 94158, USA.

|September 23, 2022

Summary

This summary is machine-generated.

Apparent diffusion coefficient (ADC) from MRI better predicts treatment response in breast cancer patients receiving immunotherapy than functional tumor volume. Early changes in ADC metrics show promise for assessing treatment effectiveness.

Keywords:

breast cancer diffusion-weighted MRI immunotherapy neoadjuvant therapy pathologic complete response

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Area of Science:

Oncology
Radiology
Medical Imaging

Background:

Neoadjuvant immunotherapy is a key treatment for locally advanced breast cancer.
Accurate early assessment of treatment response is crucial for optimizing patient management.
Diffusion-weighted MRI (DWI) and functional tumor volume (FTV) are imaging techniques used to monitor tumor changes.

Purpose of the Study:

To evaluate if changes in apparent diffusion coefficient (ADC) measured by DWI are superior to functional tumor volume (FTV) in predicting pathologic complete response (pCR) after neoadjuvant immunotherapy in locally advanced breast cancer.
To determine the independent predictive value of ADC metrics for treatment response.

Main Methods:

A randomized trial included 249 patients with locally advanced breast cancer receiving neoadjuvant chemotherapy with or without pembrolizumab.
Diffusion-weighted MRI (DWI) and DCE-MRI were performed before and 3 weeks after treatment initiation.
Percent changes in various ADC metrics (mean, 25th, 95th percentiles) and FTV were analyzed using logistic regression to predict pCR.

Main Results:

The area under the ROC curve (AUC) for the percent change in mean ADC was higher in the pembrolizumab cohort (0.73) compared to the control cohort (0.63).
In the control group, the 95th percentile ADC change showed the highest AUC (0.69).
In the pembrolizumab group, the 25th percentile ADC change achieved the highest AUC (0.75).
AUCs for FTV change were lower than for ADC metrics in both cohorts.

Conclusions:

Tumor apparent diffusion coefficient (ADC) metrics derived from DWI show potential as independent imaging markers for predicting treatment response.
ADC metrics may outperform functional tumor volume (FTV) in predicting pathologic complete response (pCR) at an early stage of neoadjuvant immunotherapy for breast cancer.