Multiparametric MRI for prediction of treatment response to neoadjuvant FOLFIRINOX therapy in borderline resectable or locally advanced pancreatic cancer.

Abstract

OBJECTIVES:

To identify multiparametric MRI biomarkers to predict the tumor response to neoadjuvant FOLFIRINOX therapy in patients with borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).

METHODS:

From May 2016 to March 2018, adult patients with BR or LA PDAC were prospectively enrolled in this study. They received eight cycles of FOLFIRINOX therapy and underwent multiparametric MRI twice (at baseline and after the second cycle). MRI evaluations included dynamic contrast-enhanced MRI, intravoxel incoherent motion diffusion-weighted imaging, and assessment of T2* relaxivity (R2*) and the change in T1 relaxivity (ΔR1, equilibrium phase R1 minus non-enhanced R1) of the tumors. Factors to predict the responders determined by the best overall response during FOLFIRINOX therapy and those to predict progression-free survival (PFS) and overall survival (OS) were evaluated using multivariable logistic regression and the Cox proportional hazard model.

RESULTS:

Forty-one patients (mean age, 60.3 years ± 9.3; 24 men) were included. Among the clinical and MRI factors, the baseline ΔR1 (adjusted odds ratio, 31.07; p = 0.008) was the only independent predictor for tumor response. The baseline ΔR1 was also an independent predictor for PFS (adjusted hazard ratio, 0.40; p = 0.033) along with R0 resection. The use of a cutoff ΔR1 value of ≥ 1.31 s-1 enabled prognostic stratification (median PFS, 16.0 months vs.10.0 months; p = 0.029; median OS, 34.9 months vs. 16.6 months; p = 0 .023, respectively).

CONCLUSIONS:

The baseline tumor ΔR1 value may be useful to predict tumor response and survival in patients with BR or LA PDAC receiving FOLFIRINOX neoadjuvant therapy.

KEY POINTS:

• Baseline ΔR1 was an independent predictor for tumor response (adjusted odds ratio, 31.07; p = 0.008) and progression-free survival (adjusted hazard ratio, 0.40; p = 0.033) in patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma receiving neoadjuvant FOLFIRINOX therapy. • The criterion of baseline ΔR1 value ≥ 1.31 s-1 allowed for the prediction of favorable tumor response and survival outcome after neoadjuvant FOLFIRINOX therapy.

• Authors: Ji Hun Kang, Seung Soo Lee, Jin Hee Kim, Jae Ho Byun, Hyoung Jung Kim, Changhoon Yoo, Kyu-Pyo Kim, Baek-Yeol Ryoo, Song Cheol Kim
• Journal: European radiology (Eur Radiol) Vol. 31 Issue 2 Pg. 864-874 (Feb 2021) ISSN: 1432-1084 [Electronic] Germany
• PMID: 32813104 (Publication Type: Journal Article)

Chemical References

• folfirinox
• Oxaliplatin
• Irinotecan
• Leucovorin
• Fluorouracil

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Fluorouracil
• Humans
• Irinotecan
• Leucovorin
• Male
• Middle Aged
• Multiparametric Magnetic Resonance Imaging
• Neoadjuvant Therapy
• Oxaliplatin
• Pancreatic Neoplasms (diagnostic imaging, drug therapy)