Predicting response to cancer immunotherapy using noninvasive radiomic biomarkers.

INTRODUCTION: Immunotherapy is regarded as one of the major breakthroughs in cancer treatment. Despite its success, only a subset of patients responds-urging the quest for predictive biomarkers. We hypothesize that artificial intelligence (AI) algorithms can automatically quantify radiographic characteristics that are related to and may therefore act as noninvasive radiomic biomarkers for immunotherapy response. PATIENTS AND METHODS: In this study, we analyzed 1055 primary and metastatic lesions from 203 patients with advanced melanoma and non-small-cell lung cancer (NSCLC) undergoing anti-PD1 therapy. We carried out an AI-based characterization of each lesion on the pretreatment contrast-enhanced CT imaging data to develop and validate a noninvasive machine learning biomarker capable of distinguishing between immunotherapy responding and nonresponding. To define the biological basis of the radiographic biomarker, we carried out gene set enrichment analysis in an independent dataset of 262 NSCLC patients. RESULTS: The biomarker reached significant performance on NSCLC lesions (up to 0.83 AUC, P < 0.001) and borderline significant for melanoma lymph nodes (0.64 AUC, P = 0.05). Combining these lesion-wide predictions on a patient level, immunotherapy response could be predicted with an AUC of up to 0.76 for both cancer types (P < 0.001), resulting in a 1-year survival difference of 24% (P = 0.02). We found highly significant associations with pathways involved in mitosis, indicating a relationship between increased proliferative potential and preferential response to immunotherapy. CONCLUSIONS: These results indicate that radiographic characteristics of lesions on standard-of-care imaging may function as noninvasive biomarkers for response to immunotherapy, and may show utility for improved patient stratification in both neoadjuvant and palliative settings.

System identification theory in pharmacokinetic modeling of dynamic contrast-enhanced MRI: influence of contrast injection.

Optimization of experimental settings of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), like the contrast administration protocol, is of great importance for reliable quantification of the microcirculatory properties, such as the volume transfer-constant K(trans). Using system identification theory and computer simulations, the confounding effects of volume, rate and multiplicity of a contrast injection on the reliability of K(trans) estimation was assessed. A new tracer-distribution model (TDM), based on in vivo data from rectal cancer patients, served to describe the relationship between the contrast agent injection and the blood time-course. A pharmacokinetic model (PKM) was used to describe the relation between the blood and tumor tissue time-courses. By means of TDM and PKM in series, the tissue-transfer function of the PKM was analyzed. As both the TDM and PKM represented low-frequency-pass filters, the energy-density at low frequencies of the blood and tissue time-courses was larger than at high frequencies. The simulations, based on measurements in humans, predict that the K(trans) is most reliable with a high injection volume administered in a single injection, where high rates only modestly improve K(trans).