PET RANO 1.0 vs. RANO 2.0 criteria for trial eligibility in IDH-wildtype glioblastoma: a retrospective, comparative...

Area of Science:

• Neuro-oncology
• Radiology
• Nuclear Medicine

Background:

• Glioblastoma clinical trials often require measurable disease for eligibility.
• Current response assessment relies on MRI-based RANO 2.0 criteria.
• Amino acid PET-based PET RANO 1.0 criteria offer standardized evaluation.

Purpose of the Study:

• To compare the frequency of measurable disease detection between PET RANO 1.0 and RANO 2.0 criteria.
• To assess these criteria at key clinical trial enrollment timepoints (T0 and T1).

Main Methods:

• Retrospective single-center study of IDH-wildtype glioblastoma patients.
• Inclusion of patients who underwent both [¹⁸F]FET PET and MRI at T0 (post-radiotherapy) or T1 (first progression).
• Independent evaluation of measurable disease by two raters using both PET RANO 1.0 and RANO 2.0 criteria.

Main Results:

• 322 patients included (112 at T0, 210 at T1).
• MRI RANO 2.0 identified measurable disease in 50.9% (T0) and 65.2% (T1).
• PET RANO 1.0 identified significantly more measurable disease: 91.1% (T0) and 95.7% (T1) (p=0.001).

Conclusions:

• PET RANO 1.0 detects a substantially larger subset of patients with measurable disease compared to RANO 2.0.
• Prospective validation of PET-based measurable disease is warranted for clinical trial inclusion criteria.
• This approach has the potential to broaden trial eligibility in IDH-wildtype glioblastoma.