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Murphy PS, Galette P, van der Aart J, Janiczek RL, Patel N, Brown AP. The role of clinical imaging in oncology drug development: progress and new challenges. Br J Radiol 2023; 96:20211126. [PMID: 37393537 PMCID: PMC10546429 DOI: 10.1259/bjr.20211126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/14/2023] [Accepted: 06/06/2023] [Indexed: 07/03/2023] Open
Abstract
In 2008, the role of clinical imaging in oncology drug development was reviewed. The review outlined where imaging was being applied and considered the diverse demands across the phases of drug development. A limited set of imaging techniques was being used, largely based on structural measures of disease evaluated using established response criteria such as response evaluation criteria in solid tumours. Beyond structure, functional tissue imaging such as dynamic contrast-enhanced MRI and metabolic measures using [18F]flourodeoxyglucose positron emission tomography were being increasingly incorporated. Specific challenges related to the implementation of imaging were outlined including standardisation of scanning across study centres and consistency of analysis and reporting. More than a decade on the needs of modern drug development are reviewed, how imaging has evolved to support new drug development demands, the potential to translate state-of-the-art methods into routine tools and what is needed to enable the effective use of this broadening clinical trial toolset. In this review, we challenge the clinical and scientific imaging community to help refine existing clinical trial methods and innovate to deliver the next generation of techniques. Strong industry-academic partnerships and pre-competitive opportunities to co-ordinate efforts will ensure imaging technologies maintain a crucial role delivering innovative medicines to treat cancer.
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Affiliation(s)
| | - Paul Galette
- Telix Pharmaceuticals (US) Inc, Fishers, United States
| | | | | | | | - Andrew P. Brown
- Vale Imaging Consultancy Solutions, Harston, Cambridge, United Kingdom
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Miller CG, Grønbæk H, Virgolini I, Kjaer A, Terve P, Bahri S, Iversen P, Svirydenka H, Rohban T, McEwan S. A novel read methodology to evaluate the optimal dose of 68Ga-satoreotide trizoxetan as a PET imaging agent in patients with gastroenteropancreatic neuroendocrine tumours: a phase II clinical trial. EJNMMI Res 2021; 11:84. [PMID: 34487283 PMCID: PMC8421477 DOI: 10.1186/s13550-021-00819-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 68Ga-satoreotide trizoxetan is a novel somatostatin receptor antagonist exhibiting higher tumour-to-background ratios and sensitivity compared to 68Ga-DOTATOC. This randomised, 2 × 3 factorial, phase II study aimed to confirm the optimal peptide mass and radioactivity ranges for 68Ga-satoreotide trizoxetan, using binary visual reading. To that end, 24 patients with metastatic gastroenteropancreatic neuroendocrine tumours received 5-20 µg of 68Ga-satoreotide trizoxetan on day 1 of the study and 30-45 µg on day 16-22, with one of three gallium-68 radioactivity ranges (40-80, 100-140, or 160-200 MBq) per visit. Two 68Ga-satoreotide trizoxetan PET/CT scans were acquired from each patient post-injection, and were scored by experienced independent blinded readers using a binary system (0 for non-optimal image quality and 1 for optimal image quality). For each patient pair of 68Ga-satoreotide trizoxetan scans, one or both images could score 1. RESULTS Total image quality score for 68Ga-satoreotide trizoxetan PET scans was lower in the 40-80 MBq radioactivity range (56.3%) compared to 100-140 MBq (90.6%) and 160-200 MBq (81.3%). Both qualitative and semi-quantitative analysis showed that peptide mass (5-20 or 30-45 µg) did not influence 68Ga-satoreotide trizoxetan imaging. There was only one reading where readers diverged on scoring; one reader preferred one image because of higher lesion conspicuity, and the other reader preferred the alternative image because of the ability to identify more lesions. CONCLUSIONS Binary visual reading, which was associated with a low inter-reader variability, has further supported that the optimal administered radioactivity of 68Ga-satoreotide trizoxetan was 100-200 MBq with a peptide mass up to 50 µg. Trial registration ClinicalTrials.gov, NCT03220217. Registered 18 July 2017, https://clinicaltrials.gov/ct2/show/NCT03220217.
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Affiliation(s)
- Colin G Miller
- The Bracken Group for Ipsen Bioscience, 12 Penns Trail, Newtown, PA, 18940, USA.
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Irene Virgolini
- Department of Nuclear Medicine, University of Innsbruck, Innsbruck, Austria
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Shadfar Bahri
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Peter Iversen
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Hanna Svirydenka
- Department of Nuclear Medicine, University of Innsbruck, Innsbruck, Austria
| | - Thomas Rohban
- Partner 4 Health for Ipsen Bioscience, Paris, France
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Oubel E, Bonnard E, Sueoka-Aragane N, Kobayashi N, Charbonnier C, Yamamichi J, Mizobe H, Kimura S. Volume-based response evaluation with consensual lesion selection: a pilot study by using cloud solutions and comparison to RECIST 1.1. Acad Radiol 2015; 22:217-25. [PMID: 25488429 DOI: 10.1016/j.acra.2014.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 09/05/2014] [Accepted: 09/20/2014] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES Lesion volume is considered as a promising alternative to Response Evaluation Criteria in Solid Tumors (RECIST) to make tumor measurements more accurate and consistent, which would enable an earlier detection of temporal changes. In this article, we report the results of a pilot study aiming at evaluating the effects of a consensual lesion selection on volume-based response (VBR) assessments. MATERIALS AND METHODS Eleven patients with lung computed tomography scans acquired at three time points were selected from Reference Image Database to Evaluate Response to therapy in lung cancer (RIDER) and proprietary databases. Images were analyzed according to RECIST 1.1 and VBR criteria by three readers working in different geographic locations. Cloud solutions were used to connect readers and carry out a consensus process on the selection of lesions used for computing response. Because there are not currently accepted thresholds for computing VBR, we have applied a set of thresholds based on measurement variability (-35% and +55%). The benefit of this consensus was measured in terms of multiobserver agreement by using Fleiss kappa (κfleiss) and corresponding standard errors (SE). RESULTS VBR after consensual selection of target lesions allowed to obtain κfleiss = 0.85 (SE = 0.091), which increases up to 0.95 (SE = 0.092), if an extra consensus on new lesions is added. As a reference, the agreement when applying RECIST without consensus was κfleiss = 0.72 (SE = 0.088). These differences were found to be statistically significant according to a z-test. CONCLUSIONS An agreement on the selection of lesions allows reducing the inter-reader variability when computing VBR. Cloud solutions showed to be an interesting and feasible strategy for standardizing response evaluations, reducing variability, and increasing consistency of results in multicenter clinical trials.
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Affiliation(s)
- Estanislao Oubel
- R&D Department, MEDIAN Technologies, Les Deux Arcs B, 1800 Route des Crêtes, Valbonne 06560, France.
| | - Eric Bonnard
- Radiology Department, Nice University Hospital, Nice, France
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Naomi Kobayashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Colette Charbonnier
- R&D Department, MEDIAN Technologies, Les Deux Arcs B, 1800 Route des Crêtes, Valbonne 06560, France
| | - Junta Yamamichi
- Global Healthcare IT Project, Medical Equipment Group, Canon Inc, Tokyo, Japan
| | - Hideaki Mizobe
- Global Healthcare IT Project, Medical Equipment Group, Canon Inc, Tokyo, Japan
| | - Shinya Kimura
- Radiology Department, Nice University Hospital, Nice, France
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Mannino FV, Amit O, Lahiri S. Evaluation of Discordance Measures in Oncology Studies with Blinded Independent Central Review of Progression-Free Survival Using an Observational Error Model. J Biopharm Stat 2013; 23:971-85. [DOI: 10.1080/10543406.2013.813516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- F. V. Mannino
- a GlaxoSmithKline , Collegeville , Pennsylvania , USA
| | - O. Amit
- a GlaxoSmithKline , Collegeville , Pennsylvania , USA
| | - S. Lahiri
- a GlaxoSmithKline , Collegeville , Pennsylvania , USA
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Walovitch RC, Chokron P, Agarwal S. US FDA draft Guidance Standard for Clinical Trial Imaging Endpoints: more than just imaging? Biomark Med 2012; 6:839-47. [DOI: 10.2217/bmm.12.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The current cost of developing a successful drug is typically over a billion dollars, with the registration trial(s) determining the success or failure of the entire development program. Often the primary endpoint of these trials is a subjective assessment. For registration trials with subjective endpoints, a regulatory agency may require a blinded independent central review (BICR) of the trial data. The BICR is a mechanism to reduce bias in open-labeled trials and to potentially increase accuracy and precision. A decision tree algorithm has been developed that can be used to determine when and what type of a BICR is needed. The US FDA draft Guidance Standard for Clinical Trial Imaging Endpoints can be used as an effective process map in exploring the value and use of BICRs in imaging, and in any hard to interpret variable subjective assessment in general.
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Affiliation(s)
| | - Patrick Chokron
- WorldCare Clinical, LLC, 7 Bulfinch Place, Boston, MA 02114, USA
| | - Sheela Agarwal
- Massachusetts General Hospital, Division of Abdominal & Interventional Radiology, 55 Fruit Street, Boston, MA 02114, USA
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Amit O, Mannino F, Stone A, Bushnell W, Denne J, Helterbrand J, Burger H. Blinded independent central review of progression in cancer clinical trials: Results from a meta-analysis. Eur J Cancer 2011; 47:1772-8. [DOI: 10.1016/j.ejca.2011.02.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/16/2011] [Indexed: 11/17/2022]
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Dodd LE, Korn EL, Freidlin B, Rubinstein LV, Mooney MM, Jaffe CC, Dancey J. In Reply. J Clin Oncol 2009. [DOI: 10.1200/jco.2008.21.4411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - C. Carl Jaffe
- Radiology Department, Boston University School of Medicine, Boston, MA
| | - Janet Dancey
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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