Evaluation of Standard Response Assessment in Neuro-Oncology, Modified Response Assessment in Neuro-Oncology, and Immunotherapy Response Assessment in Neuro-Oncology in Newly Diagnosed and Recurrent Glioblastoma

Author:

Youssef Gilbert1ORCID,Rahman Rifaquat2ORCID,Bay Camden3,Wang Wei456,Lim-Fat Mary Jane7,Arnaout Omar8,Bi Wenya Linda8ORCID,Cagney Daniel N.9,Chang Yuh-Shin1011ORCID,Cloughesy Timothy F.1213ORCID,DeSalvo Matthew3ORCID,Ellingson Benjamin M.14151617ORCID,Flood Thomas F.3,Gerstner Elizabeth R.18,Gonzalez Castro L. Nicolas14ORCID,Guenette Jeffrey P.3ORCID,Kim Albert E.18ORCID,Lee Eudocia Q.1ORCID,McFaline-Figueroa Jose R.1,Potter Christopher A.3ORCID,Reardon David A.1ORCID,Huang Raymond Y.3ORCID,Wen Patrick Y.1ORCID

Affiliation:

1. Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA

2. Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA

3. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

4. Department of Neurology, Brigham and Women's Hospital, Boston, MA

5. Department of Medicine, Brigham and Women's Hospital, Boston, MA

6. Division of Sleep Medicine, Harvard Medical School, Boston, MA

7. Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

8. Department of Neurosurgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA

9. Radiotherapy Department, Mater Private Network, Dublin, Ireland

10. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA

11. Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA

12. UCLA Neuro-Oncology Program, University of California Los Angeles, Los Angeles, CA

13. Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA

14. UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, Los Angeles, CA

15. Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA

16. Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA

17. Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA

18. Department of Neurology, Massachusetts General Hospital, Boston, MA

Abstract

PURPOSE The Response Assessment in Neuro-Oncology (RANO) criteria are widely used in high-grade glioma clinical trials. We compared the RANO criteria with updated modifications (modified RANO [mRANO] and immunotherapy RANO [iRANO] criteria) in patients with newly diagnosed glioblastoma (nGBM) and recurrent GBM (rGBM) to evaluate the performance of each set of criteria and inform the development of the planned RANO 2.0 update. MATERIALS AND METHODS Evaluation of tumor measurements and fluid-attenuated inversion recovery (FLAIR) sequences were performed by blinded readers to determine disease progression using RANO, mRANO, iRANO, and other response assessment criteria. Spearman's correlations between progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS Five hundred twenty-six nGBM and 580 rGBM cases were included. Spearman's correlations were similar between RANO and mRANO (0.69 [95% CI, 0.62 to 0.75] v 0.67 [95% CI, 0.60 to 0.73]) in nGBM and rGBM (0.48 [95% CI, 0.40 to 0.55] v 0.50 [95% CI, 0.42 to 0.57]). In nGBM, requirement of a confirmation scan within 12 weeks of completion of radiotherapy to determine progression was associated with improved correlations. Use of the postradiation magnetic resonance imaging (MRI) as baseline scan was associated with improved correlation compared with use of the pre-radiation MRI (0.67 [95% CI, 0.60 to 0.73] v 0.53 [95% CI, 0.42 to 0.62]). Evaluation of FLAIR sequences did not improve the correlation. Among patients who received immunotherapy, Spearman's correlations were similar among RANO, mRANO, and iRANO. CONCLUSION RANO and mRANO demonstrated similar correlations between PFS and OS. Confirmation scans were only beneficial in nGBM within 12 weeks of completion of radiotherapy, and there was a trend in favor of the use of postradiation MRI as the baseline scan in nGBM. Evaluation of FLAIR can be omitted. The iRANO criteria did not add significant benefit in patients who received immune checkpoint inhibitors.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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