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Neuro Oncol. 2015 Aug;17(8):1139-47. doi: 10.1093/neuonc/nov028. Epub 2015 Mar 9.

Relative cerebral blood volume is a potential predictive imaging biomarker of bevacizumab efficacy in recurrent glioblastoma.

Author information

1
Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany (P.K., S.B., S.H., M.B., A.R.); Neurology Clinic, University of Heidelberg Medical Center, Heidelberg, Germany (B.W., A.W., W.W.); German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ, Heidelberg, Germany (B.W., W.W.); Department of Neurology, Medical University Innsbruck, Innsbruck, Austria (M.N.); Department of Radiology, DKFZ, Heidelberg, Germany (H.-P.S., A.R.).

Abstract

BACKGROUND:

To analyze the relevance of dynamic susceptibility-weighted contrast-enhanced MRI (DSC-MRI) derived relative cerebral blood volume (rCBV) analysis for predicting response to bevacizumab (BEV) in patients with recurrent glioblastoma (rGB).

METHODS:

A total of 127 patients diagnosed with rGB receiving either bevacizumab (71 patients, BEV cohort) or alkylating chemotherapy (56 patients, non-BEV cohort) underwent conventional anatomic MRI and DSC-MRI at baseline and at first follow-up after treatment initiation. The mean rCBV of the contrast-enhancing tumor (cT1) as well as cT1 and fluid-attenuated inversion recovery (FLAIR) volumes at both time points were correlated with progression-free survival (PFS) and overall survival (OS) using Cox proportional hazard models, logistic regression, and the log-rank test.

RESULTS:

Baseline rCBV was associated with both PFS (hazard ratio [HR] = 1.3; P < .01) and OS (HR = 1.3; P < .01) in the BEV cohort and predicted 6-month PFS in 82% and 12-month OS in 79% of patients, whereas it was not associated with PFS (HR = 1.0; P = .70) or OS (HR = 1.0; P = .47) in the non-BEV cohort. Corresponding median OS and PFS rates in the BEV cohort for patients with rCBV-values less than 3.92 (optimal threshold from receiver operating characteristic [ROC] analysis of 12-month OS data) were 14.2 and 6.0 months, as compared to 6.6 and 2.8 months for patients with rCBV-values greater than 3.92 (P < .01, respectively). cT1 and FLAIR volumes at first follow-up were significant predictors of 6-month PFS and 12-month OS in the BEV cohort but not in the non-BEV cohort. Corresponding volumes at baseline were not significant in any cohort.

CONCLUSIONS:

Pretreatment rCBV is a potential predictive imaging biomarker in BEV-treated rGB but not alkylating chemotherapy-treated rGB, which is superior to volumetric analysis of conventional anatomic MRI and predicts 6-month PFS and 12-month OS in 80% of BEV-treated patients.

KEYWORDS:

bevacizumab; biomarker; cerebral blood volume; glioblastoma; rCBV

PMID:
25754089
PMCID:
PMC4490872
DOI:
10.1093/neuonc/nov028
[Indexed for MEDLINE]
Free PMC Article

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