Diffusion weighted MRI and apparent diffusion coefficient as a prognostic biomarker in evaluating chemotherapy-antiangiogenic treated stage IV non-small cell lung cancer: A prospective, single-arm, open-label, clinical trial (BevMar)

• Published in: European journal of radiology 2024-08, Vol.177, p.111557, Article 111557
• Main Authors: Grundberg, Oscar, Skribek, Marcus, Swerkersson, Signe, Skorpil, Mikael, Kölbeck, Karl, Grozman, Vitali, Nyren, Sven, Tsakonas, Georgios
• Format: Article
• Language: English
• Subjects: Antiangiogenic therapy; Diffusion weighted MRI; Non-small cell lung cancer; Prognostic marker; VEGF
• ISSN: 0720-048X; 1872-7727; 1872-7727
• DOI: 10.1016/j.ejrad.2024.111557

When treating Lung Cancer, it is necessary to identify early treatment failure to enable timely therapeutic adjustments. The Aim of this study was to investigate whether changes in tumor diffusion during treatment with chemotherapy and bevacizumab could serve as a predictor of treatment failure. A prospective single-arm, open-label, clinical trial was conducted between September 2014 and December 2020, enrolling patients with stage IV non-small cell lung cancer (NSCLC). The patients were treated with chemotherapy-antiangiogenic combination. Diffusion weighted magnetic resonance imaging (DW-MRI) was performed at baseline, two, four, and sixteen weeks after initiating treatment. The differences in apparent diffusion coefficient (ADC) values between pre- and post-treatment MRIs were recorded as Delta values (ΔADC). We assessed whether ΔADC could serve as a prognostic biomarker for overall survival (OS), with a five year follow up. 18 patients were included in the final analysis. Patients with a ΔADC value ≥ -3 demonstrated a significantly longer OS with an HR of 0.12 (95 % CI; 0.03– 0.61; p = 0.003) The median OS in patients with a ΔADC value ≥ -3 was 18 months, (95 % C.I; 7–46) compared to 7 months (95 % C.I; 5–9) in those with a ΔADC value