Early treatment re-direction based on functional tumor volume at 3 and 6-week MRI for breast cancer patients undergoing neoadjuvant chemotherapy
Natsuko Onishi1, Jessica Gibbs1, Wen Li1, David C. Newitt1, Elissa R. Price1, Barbara LeStage2, William F. Symmans3, Angela DeMichele4, Christina Yau5, The I-SPY 2 Imaging Working Group6, The I-SPY 2 Consortium6, Laura J. Esserman5, and Nola M. Hylton1
1Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States, 2I-SPY 2 Advocacy Group, San Francisco, CA, United States, 3MD Anderson Cancer Center, Houston, TX, United States, 4University of Pennsylvania, Philadelphia, PA, United States, 5Department of Surgery, University of California, San Francisco, San Francisco, CA, United States, 6Quantum Leap Healthcare Collaborative, San Francisco, CA, United States
In the I-SPY2 breast cancer trial, functional tumor volume (FTV) derived from dynamic contrast-enhanced MRI is used as a longitudinal measure of response to adjust patient randomization and evaluate drug efficacy. I-SPY2 is introducing a treatment “escalation” option, giving patients the opportunity to re-direct to potentially more effective treatment based on early indication of inferior response by MRI. We retrospectively investigated the ability of FTV reduction to predict inferior outcome. Combined criteria using FTV reduction at 3 and 6 weeks of treatment showed high PPV and high sensitivity in early detection of non-responders.
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