A Comparative Retrospective Study of Immunotherapy RANO Versus Standard RANO Criteria in Glioblastoma Patients Receiving Immune Checkpoint Inhibitor Therapy
ObjectivesReal-time assessment of treatment response in glioblastoma (GBM) patients on immune checkpoint blockade (ICB) remains challenging because inflammatory effects of therapy may mimic progressive disease, and the temporal evolution of these inflammatory findings is poorly understood. We compar...
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| Format: | Article |
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Frontiers Media S.A.
2021-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.679331/full |
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| author | Xin Chen Xin Chen Mary Jane Lim-Fat Lei Qin Lei Qin Angie Li Angie Li Annie Bryant Camden P. Bay Lu Gao Lu Gao Nityanand Miskin Nityanand Miskin Zaiyi Liu J. Bryan Iorgulescu Xiaoyin Xu Xiaoyin Xu David A. Reardon David A. Reardon Geoffrey S. Young Geoffrey S. Young Geoffrey S. Young |
| author_facet | Xin Chen Xin Chen Mary Jane Lim-Fat Lei Qin Lei Qin Angie Li Angie Li Annie Bryant Camden P. Bay Lu Gao Lu Gao Nityanand Miskin Nityanand Miskin Zaiyi Liu J. Bryan Iorgulescu Xiaoyin Xu Xiaoyin Xu David A. Reardon David A. Reardon Geoffrey S. Young Geoffrey S. Young Geoffrey S. Young |
| author_sort | Xin Chen |
| collection | DOAJ |
| description | ObjectivesReal-time assessment of treatment response in glioblastoma (GBM) patients on immune checkpoint blockade (ICB) remains challenging because inflammatory effects of therapy may mimic progressive disease, and the temporal evolution of these inflammatory findings is poorly understood. We compare GBM patient response during ICB as assessed with the Immunotherapy Response Assessment in Neuro-Oncology (iRANO) and the standard Response Assessment in Neuro-Oncology (RANO) radiological criteria.Methods49 GBM patients (seven newly diagnosed and 42 recurrent) treated with ICBs at a single institution were identified. Tumor burden was quantified on serial MR scans according to RANO criteria during ICB. Radiographic response assessment by iRANO and RANO were compared.Results82% (40/49) of patients received anti–PD-1, 16% (8/49) received anti-PD-L1, and 2% (1/49) received anti-PD-1 and anti-CTLA4 treatment. Change in tumor burden and best overall response ranged from −100 to +557% (median: +48%). 12% (6/49) of patients were classified as concordant non-progressors by both RANO and iRANO (best response: one CR, one PR, and four SD). Another12% (6/49) had discordant assessments: 15% (6/41) of RANO grade progressive disease (PD) patients had iRANO grade of progressive disease unconfirmed (PDU). The final classification of these discordant patients was pseudoprogression (PsP) in three of six, PD in two of six, and PDU in one of six who went off study before the iRANO assessment of PDU. iRANO delayed diagnosis of PD by 42 and 93 days in the two PD patients. 76% (37/49) patients were classified as concordant PD by both RANO and iRANO. 12% (6/49) of all patients were classified as PsP, starting at a median of 12 weeks (range, 4–30 weeks) after ICB initiation.ConclusionsStandard RANO and iRANO have high concordance for assessing PD in patients within 6 months of ICB initiation. iRANO was beneficial in 6% (3/49) cases later proven to be PsP, but delayed confirmation of PD by <3 months in 4% (2/49). PsP occurred in 12% of patients, starting at up to 7 months after initiation of ICB. Further study to define the utility of modified RANO compared with iRANO in ICB GBM patients is needed. |
| first_indexed | 2024-12-17T03:49:22Z |
| format | Article |
| id | doaj.art-388fe83b8b604e1a9d66a0b19cb2db1d |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-17T03:49:22Z |
| publishDate | 2021-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-388fe83b8b604e1a9d66a0b19cb2db1d2022-12-21T22:04:49ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-06-011110.3389/fonc.2021.679331679331A Comparative Retrospective Study of Immunotherapy RANO Versus Standard RANO Criteria in Glioblastoma Patients Receiving Immune Checkpoint Inhibitor TherapyXin Chen0Xin Chen1Mary Jane Lim-Fat2Lei Qin3Lei Qin4Angie Li5Angie Li6Annie Bryant7Camden P. Bay8Lu Gao9Lu Gao10Nityanand Miskin11Nityanand Miskin12Zaiyi Liu13J. Bryan Iorgulescu14Xiaoyin Xu15Xiaoyin Xu16David A. Reardon17David A. Reardon18Geoffrey S. Young19Geoffrey S. Young20Geoffrey S. Young21Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United StatesDepartment of Radiology, Guangzhou First People’s Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, ChinaDivision of Neurology, Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, CanadaDepartment of Imaging, Dana-Farber Cancer Institute, Boston, MA, United StatesDepartment of Radiology, Harvard Medical School, Boston, MA, United StatesDepartment of Radiology, Brigham and Women’s Hospital, Boston, MA, United StatesDepartment of Family Medicine, University of California, Riverside School of Medicine, Riverside, CA, United StatesDepartment of Imaging, Dana-Farber Cancer Institute, Boston, MA, United StatesDepartment of Radiology, Brigham and Women’s Hospital, Boston, MA, United StatesDepartment of Radiology, Brigham and Women’s Hospital, Boston, MA, United StatesDepartment of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Radiology, Brigham and Women’s Hospital, Boston, MA, United StatesDepartment of Radiology, Harvard Medical School, Boston, MA, United StatesDepartment of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, ChinaDepartment of Pathology, Brigham and Women’s Hospital, Boston, MA, United StatesDepartment of Radiology, Brigham and Women’s Hospital, Boston, MA, United StatesDepartment of Radiology, Harvard Medical School, Boston, MA, United States0Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, United States1Department of Medicine, Harvard Medical School, Boston, MA, United StatesDepartment of Radiology, Brigham and Women’s Hospital, Boston, MA, United StatesDepartment of Imaging, Dana-Farber Cancer Institute, Boston, MA, United StatesDepartment of Radiology, Harvard Medical School, Boston, MA, United StatesObjectivesReal-time assessment of treatment response in glioblastoma (GBM) patients on immune checkpoint blockade (ICB) remains challenging because inflammatory effects of therapy may mimic progressive disease, and the temporal evolution of these inflammatory findings is poorly understood. We compare GBM patient response during ICB as assessed with the Immunotherapy Response Assessment in Neuro-Oncology (iRANO) and the standard Response Assessment in Neuro-Oncology (RANO) radiological criteria.Methods49 GBM patients (seven newly diagnosed and 42 recurrent) treated with ICBs at a single institution were identified. Tumor burden was quantified on serial MR scans according to RANO criteria during ICB. Radiographic response assessment by iRANO and RANO were compared.Results82% (40/49) of patients received anti–PD-1, 16% (8/49) received anti-PD-L1, and 2% (1/49) received anti-PD-1 and anti-CTLA4 treatment. Change in tumor burden and best overall response ranged from −100 to +557% (median: +48%). 12% (6/49) of patients were classified as concordant non-progressors by both RANO and iRANO (best response: one CR, one PR, and four SD). Another12% (6/49) had discordant assessments: 15% (6/41) of RANO grade progressive disease (PD) patients had iRANO grade of progressive disease unconfirmed (PDU). The final classification of these discordant patients was pseudoprogression (PsP) in three of six, PD in two of six, and PDU in one of six who went off study before the iRANO assessment of PDU. iRANO delayed diagnosis of PD by 42 and 93 days in the two PD patients. 76% (37/49) patients were classified as concordant PD by both RANO and iRANO. 12% (6/49) of all patients were classified as PsP, starting at a median of 12 weeks (range, 4–30 weeks) after ICB initiation.ConclusionsStandard RANO and iRANO have high concordance for assessing PD in patients within 6 months of ICB initiation. iRANO was beneficial in 6% (3/49) cases later proven to be PsP, but delayed confirmation of PD by <3 months in 4% (2/49). PsP occurred in 12% of patients, starting at up to 7 months after initiation of ICB. Further study to define the utility of modified RANO compared with iRANO in ICB GBM patients is needed.https://www.frontiersin.org/articles/10.3389/fonc.2021.679331/fullglioblastomaimmunotherapymagnetic resonance imagingdisease progressionpseudoprogressionresponse assessment in neuro-oncology criteria |
| spellingShingle | Xin Chen Xin Chen Mary Jane Lim-Fat Lei Qin Lei Qin Angie Li Angie Li Annie Bryant Camden P. Bay Lu Gao Lu Gao Nityanand Miskin Nityanand Miskin Zaiyi Liu J. Bryan Iorgulescu Xiaoyin Xu Xiaoyin Xu David A. Reardon David A. Reardon Geoffrey S. Young Geoffrey S. Young Geoffrey S. Young A Comparative Retrospective Study of Immunotherapy RANO Versus Standard RANO Criteria in Glioblastoma Patients Receiving Immune Checkpoint Inhibitor Therapy Frontiers in Oncology glioblastoma immunotherapy magnetic resonance imaging disease progression pseudoprogression response assessment in neuro-oncology criteria |
| title | A Comparative Retrospective Study of Immunotherapy RANO Versus Standard RANO Criteria in Glioblastoma Patients Receiving Immune Checkpoint Inhibitor Therapy |
| title_full | A Comparative Retrospective Study of Immunotherapy RANO Versus Standard RANO Criteria in Glioblastoma Patients Receiving Immune Checkpoint Inhibitor Therapy |
| title_fullStr | A Comparative Retrospective Study of Immunotherapy RANO Versus Standard RANO Criteria in Glioblastoma Patients Receiving Immune Checkpoint Inhibitor Therapy |
| title_full_unstemmed | A Comparative Retrospective Study of Immunotherapy RANO Versus Standard RANO Criteria in Glioblastoma Patients Receiving Immune Checkpoint Inhibitor Therapy |
| title_short | A Comparative Retrospective Study of Immunotherapy RANO Versus Standard RANO Criteria in Glioblastoma Patients Receiving Immune Checkpoint Inhibitor Therapy |
| title_sort | comparative retrospective study of immunotherapy rano versus standard rano criteria in glioblastoma patients receiving immune checkpoint inhibitor therapy |
| topic | glioblastoma immunotherapy magnetic resonance imaging disease progression pseudoprogression response assessment in neuro-oncology criteria |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.679331/full |
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