Promise and pitfalls of quantitative imaging in oncology clinical trials.
Quantitative imaging using computed tomography, magnetic resonance imaging and positron emission tomography modalities will play an increasingly important role in the design of oncology trials addressing molecularly targeted, personalized therapies. The advent of molecularly targeted therapies, exemplified by antiangiogenic drugs, creates new complexities in the assessment of response. The Quantitative Imaging Network addresses the need for imaging modalities which can accurately and reproducibly measure not just change in tumor size but changes in relevant metabolic parameters, modulation of relevant signaling pathways, drug delivery to tumor and differentiation of apoptotic cell death from other changes in tumor volume. This article provides an overview of the applications of quantitative imaging to phase 0 through phase 3 oncology trials. We describe the use of a range of quantitative imaging modalities in specific tumor types including malignant gliomas, lung cancer, head and neck cancer, lymphoma, breast cancer, prostate cancer and sarcoma. In the concluding section, we discuss potential constraints on clinical trials using quantitative imaging, including complexity of trial conduct, impact on subject recruitment, incremental costs and institutional barriers. Strategies for overcoming these constraints are presented.
Fred Hutchinson Cancer Research Center, Seattle, WA 98019, USA. bkurland@fhcrc.org
Brenda F
BF
Kurland
Elizabeth R
ER
Gerstner
James M
JM
Mountz
Lawrence H
LH
Schwartz
Christopher W
CW
Ryan
Michael M
MM
Graham
John M
JM
Buatti
Fiona M
FM
Fennessy
Edward A
EA
Eikman
Virendra
V
Kumar
Kenneth M
KM
Forster
Richard L
RL
Wahl
Frank S
FS
Lieberman
D017209:Apoptosis; D015415:Biomarkers / Q000378:metabolism; D002454:Cell Differentiation; D002986:Clinical Trials as Topic; D003952:Diagnostic Imaging / Q000379:methods*; D016503:Drug Delivery Systems; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008495:Medical Oncology / Q000379:methods*; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy*; D049268:Positron-Emission Tomography / Q000379:methods; D015398:Signal Transduction; D014057:Tomography, X-Ray Computed / Q000379:methods
D015415:Biomarkers