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Barbe R, Belkouchi Y, Menu Y, Cohen R, David C, Kind M, Harguem S, Dawi L, Hadchiti J, Selhane F, Billet N, Ammari S, Bertin A, Lawrance L, Cervantes B, Hollebecque A, Balleyguier C, Cournede PH, Talbot H, Lassau N, Andre T. Imaging-guided prognostic score-based approach to assess the benefits of combotherapy versus monotherapy with immune checkpoint inhibitors in metastatic MSI-H colorectal cancer patients. Eur J Cancer 2024; 202:114020. [PMID: 38502988 DOI: 10.1016/j.ejca.2024.114020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND This retrospective study determined survival responses to immune checkpoint inhibitors (ICIs), comparing mono- (mono) and combo-immunotherapy (combo) in patients with microsatellite instability-high (MSI-H) metastatic colorectal cancer (mCRC) by analyzing quantitative imaging data and clinical factors. METHODS One hundred fifty patients were included from two centers and divided into training (n = 105) and validation (n = 45) cohorts. Radiologists manually annotated chest-abdomen-pelvis computed tomography and calculated tumor burden. Progression-free survival (PFS) was assessed, and variables were selected through Recursive Feature Elimination. Cutoff values were determined using maximally selected rank statistics to binarize features, forming a risk score with hazard ratio-derived weights. RESULTS In total, 2258 lesions were annotated with excellent reproducibility. Key variables in the training cohort included: total tumor volume (cutoff: 73 cm3), lesion count (cutoff: 20), age (cutoff: 60) and the presence of peritoneal carcinomatosis. Their respective weights were 1.13, 0.96, 0.91, and 0.38, resulting in a risk score cutoff of 1.36. Low-score patients showed similar overall survival and PFS regardless of treatment, while those with a high-score had significantly worse survivals with mono vs combo (P = 0.004 and P = 0.0001). In the validation set, low-score patients exhibited no significant difference in overall survival and PFS with mono or combo. However, patients with a high-score had worse PFS with mono (P = 0.046). CONCLUSIONS A score based on total tumor volume, lesion count, the presence of peritoneal carcinomatosis, and age can guide MSI-H mCRC treatment decisions, allowing oncologists to identify suitable candidates for mono and combo ICI therapies.
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Affiliation(s)
- Rémy Barbe
- Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Younes Belkouchi
- Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France; Université Paris-Saclay, Centrale-Supelec, Centre de vision numérique, Gif-Sur-Yvette, France
| | - Yves Menu
- Département d'imagerie, Gustave Roussy, Villejuif, France; SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France
| | - Romain Cohen
- SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France
| | - Clemence David
- Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Michele Kind
- Département d'imagerie, Institut Bergonié, Bordeaux, France
| | - Sana Harguem
- Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Lama Dawi
- Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Joya Hadchiti
- Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Fatine Selhane
- Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Nicolas Billet
- Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Samy Ammari
- Département d'imagerie, Gustave Roussy, Villejuif, France; Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Ambroise Bertin
- Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Littisha Lawrance
- Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Baptiste Cervantes
- SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France
| | - Antoine Hollebecque
- Département d'Innovation Thérapeutique et Essais Précoces (DITEP), Gustave Roussy, Villejuif, France
| | - Corinne Balleyguier
- Département d'imagerie, Gustave Roussy, Villejuif, France; Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Paul-Henry Cournede
- Université Paris-Saclay, Centrale-Supelec, Lab of Mathematics and Informatics, Gif-Sur-Yvette, France
| | - Hugues Talbot
- Université Paris-Saclay, Centrale-Supelec, Centre de vision numérique, Gif-Sur-Yvette, France
| | - Nathalie Lassau
- Département d'imagerie, Gustave Roussy, Villejuif, France; Laboratoire BIOMAPS, CNRS, INSERM, CEA, Université Paris Saclay, Villejuif, France
| | - Thierry Andre
- SIRIC CURAMUS, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France.
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