Low incidence of pseudoprogression by imaging in newly diagnosed glioblastoma patients treatedwith cediranib in combinationwith chemoradiation

Marco C. Pinho, Pavlina Polaskova, Jayashree Kalpathy-Cramer, Dominique Jennings, Kyrre E. Emblem, Rakesh K. Jain, Bruce R. Rosen, Patrick Y. Wen, A. Gregory Sorensen, Tracy T. Batchelor, Elizabeth R. Gerstner

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background. Chemoradiation (CRT) can significantly modify the radiographic appearance of malignant gliomas, especially within the immediate post-CRT period. Pseudoprogression (PsP) is an increasingly recognized phenomenon in this setting, and is thought to be secondary to increased permeability as a byproduct of the complex process of radiation-induced tissue injury, possibly enhanced by temozolomide. We sought to determine whether the addition of a vascular endothelial growth factor (VEGF) signaling inhibitor (cediranib) to conventional CRT had an impact on the frequency of PsP, by comparing two groups of patients with newly diagnosed glioblastoma before, during, and after CRT. Methods. All patients underwent serial magnetic resonance imaging as part of institutional review board-approved clinical studies. Eleven patients in the control group received only chemoradiation, whereas 29 patients in the study group received chemoradiation and cediranib until disease progression or toxicity. Response assessment was defined according to Response Assessment in Neuro-Oncology criteria, and patients with enlarging lesions were classified into true tumor progressions (TTP) or PsP, based on serial radiographic follow-up. Results. Two patients in the study group (7%) showed signs of apparent early tumor progression, and both were subsequently classified as TTP. Six patients in the control group (54%) showed signs of apparent early tumor progression, and three were subsequently classified as TTP and three as PsP.The frequency of PsP was significantly higher in the control group. Conclusion. Administration of a VEGF inhibitor during and after CRT modifies the expression of PsP by imaging.

Original languageEnglish (US)
Pages (from-to)75-81
Number of pages7
JournalOncologist
Volume19
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Glioblastoma
Incidence
temozolomide
Neoplasms
Control Groups
Vascular Endothelial Growth Factor A
Research Ethics Committees
cediranib
Glioma
Disease Progression
Permeability
Magnetic Resonance Imaging
Radiation
Wounds and Injuries

Keywords

  • Cediranib
  • Glioblastoma
  • Pseudoprogression
  • Vascular endothelial growth factor

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Pinho, M. C., Polaskova, P., Kalpathy-Cramer, J., Jennings, D., Emblem, K. E., Jain, R. K., ... Gerstner, E. R. (2014). Low incidence of pseudoprogression by imaging in newly diagnosed glioblastoma patients treatedwith cediranib in combinationwith chemoradiation. Oncologist, 19(1), 75-81. https://doi.org/10.1634/theoncologist.2013-0101

Low incidence of pseudoprogression by imaging in newly diagnosed glioblastoma patients treatedwith cediranib in combinationwith chemoradiation. / Pinho, Marco C.; Polaskova, Pavlina; Kalpathy-Cramer, Jayashree; Jennings, Dominique; Emblem, Kyrre E.; Jain, Rakesh K.; Rosen, Bruce R.; Wen, Patrick Y.; Sorensen, A. Gregory; Batchelor, Tracy T.; Gerstner, Elizabeth R.

In: Oncologist, Vol. 19, No. 1, 2014, p. 75-81.

Research output: Contribution to journalArticle

Pinho, MC, Polaskova, P, Kalpathy-Cramer, J, Jennings, D, Emblem, KE, Jain, RK, Rosen, BR, Wen, PY, Sorensen, AG, Batchelor, TT & Gerstner, ER 2014, 'Low incidence of pseudoprogression by imaging in newly diagnosed glioblastoma patients treatedwith cediranib in combinationwith chemoradiation', Oncologist, vol. 19, no. 1, pp. 75-81. https://doi.org/10.1634/theoncologist.2013-0101
Pinho, Marco C. ; Polaskova, Pavlina ; Kalpathy-Cramer, Jayashree ; Jennings, Dominique ; Emblem, Kyrre E. ; Jain, Rakesh K. ; Rosen, Bruce R. ; Wen, Patrick Y. ; Sorensen, A. Gregory ; Batchelor, Tracy T. ; Gerstner, Elizabeth R. / Low incidence of pseudoprogression by imaging in newly diagnosed glioblastoma patients treatedwith cediranib in combinationwith chemoradiation. In: Oncologist. 2014 ; Vol. 19, No. 1. pp. 75-81.
@article{6ad4be2a0ef14c28914cf4ee4ce0e4e9,
title = "Low incidence of pseudoprogression by imaging in newly diagnosed glioblastoma patients treatedwith cediranib in combinationwith chemoradiation",
abstract = "Background. Chemoradiation (CRT) can significantly modify the radiographic appearance of malignant gliomas, especially within the immediate post-CRT period. Pseudoprogression (PsP) is an increasingly recognized phenomenon in this setting, and is thought to be secondary to increased permeability as a byproduct of the complex process of radiation-induced tissue injury, possibly enhanced by temozolomide. We sought to determine whether the addition of a vascular endothelial growth factor (VEGF) signaling inhibitor (cediranib) to conventional CRT had an impact on the frequency of PsP, by comparing two groups of patients with newly diagnosed glioblastoma before, during, and after CRT. Methods. All patients underwent serial magnetic resonance imaging as part of institutional review board-approved clinical studies. Eleven patients in the control group received only chemoradiation, whereas 29 patients in the study group received chemoradiation and cediranib until disease progression or toxicity. Response assessment was defined according to Response Assessment in Neuro-Oncology criteria, and patients with enlarging lesions were classified into true tumor progressions (TTP) or PsP, based on serial radiographic follow-up. Results. Two patients in the study group (7{\%}) showed signs of apparent early tumor progression, and both were subsequently classified as TTP. Six patients in the control group (54{\%}) showed signs of apparent early tumor progression, and three were subsequently classified as TTP and three as PsP.The frequency of PsP was significantly higher in the control group. Conclusion. Administration of a VEGF inhibitor during and after CRT modifies the expression of PsP by imaging.",
keywords = "Cediranib, Glioblastoma, Pseudoprogression, Vascular endothelial growth factor",
author = "Pinho, {Marco C.} and Pavlina Polaskova and Jayashree Kalpathy-Cramer and Dominique Jennings and Emblem, {Kyrre E.} and Jain, {Rakesh K.} and Rosen, {Bruce R.} and Wen, {Patrick Y.} and Sorensen, {A. Gregory} and Batchelor, {Tracy T.} and Gerstner, {Elizabeth R.}",
year = "2014",
doi = "10.1634/theoncologist.2013-0101",
language = "English (US)",
volume = "19",
pages = "75--81",
journal = "Oncologist",
issn = "1083-7159",
publisher = "AlphaMed Press",
number = "1",

}

TY - JOUR

T1 - Low incidence of pseudoprogression by imaging in newly diagnosed glioblastoma patients treatedwith cediranib in combinationwith chemoradiation

AU - Pinho, Marco C.

AU - Polaskova, Pavlina

AU - Kalpathy-Cramer, Jayashree

AU - Jennings, Dominique

AU - Emblem, Kyrre E.

AU - Jain, Rakesh K.

AU - Rosen, Bruce R.

AU - Wen, Patrick Y.

AU - Sorensen, A. Gregory

AU - Batchelor, Tracy T.

AU - Gerstner, Elizabeth R.

PY - 2014

Y1 - 2014

N2 - Background. Chemoradiation (CRT) can significantly modify the radiographic appearance of malignant gliomas, especially within the immediate post-CRT period. Pseudoprogression (PsP) is an increasingly recognized phenomenon in this setting, and is thought to be secondary to increased permeability as a byproduct of the complex process of radiation-induced tissue injury, possibly enhanced by temozolomide. We sought to determine whether the addition of a vascular endothelial growth factor (VEGF) signaling inhibitor (cediranib) to conventional CRT had an impact on the frequency of PsP, by comparing two groups of patients with newly diagnosed glioblastoma before, during, and after CRT. Methods. All patients underwent serial magnetic resonance imaging as part of institutional review board-approved clinical studies. Eleven patients in the control group received only chemoradiation, whereas 29 patients in the study group received chemoradiation and cediranib until disease progression or toxicity. Response assessment was defined according to Response Assessment in Neuro-Oncology criteria, and patients with enlarging lesions were classified into true tumor progressions (TTP) or PsP, based on serial radiographic follow-up. Results. Two patients in the study group (7%) showed signs of apparent early tumor progression, and both were subsequently classified as TTP. Six patients in the control group (54%) showed signs of apparent early tumor progression, and three were subsequently classified as TTP and three as PsP.The frequency of PsP was significantly higher in the control group. Conclusion. Administration of a VEGF inhibitor during and after CRT modifies the expression of PsP by imaging.

AB - Background. Chemoradiation (CRT) can significantly modify the radiographic appearance of malignant gliomas, especially within the immediate post-CRT period. Pseudoprogression (PsP) is an increasingly recognized phenomenon in this setting, and is thought to be secondary to increased permeability as a byproduct of the complex process of radiation-induced tissue injury, possibly enhanced by temozolomide. We sought to determine whether the addition of a vascular endothelial growth factor (VEGF) signaling inhibitor (cediranib) to conventional CRT had an impact on the frequency of PsP, by comparing two groups of patients with newly diagnosed glioblastoma before, during, and after CRT. Methods. All patients underwent serial magnetic resonance imaging as part of institutional review board-approved clinical studies. Eleven patients in the control group received only chemoradiation, whereas 29 patients in the study group received chemoradiation and cediranib until disease progression or toxicity. Response assessment was defined according to Response Assessment in Neuro-Oncology criteria, and patients with enlarging lesions were classified into true tumor progressions (TTP) or PsP, based on serial radiographic follow-up. Results. Two patients in the study group (7%) showed signs of apparent early tumor progression, and both were subsequently classified as TTP. Six patients in the control group (54%) showed signs of apparent early tumor progression, and three were subsequently classified as TTP and three as PsP.The frequency of PsP was significantly higher in the control group. Conclusion. Administration of a VEGF inhibitor during and after CRT modifies the expression of PsP by imaging.

KW - Cediranib

KW - Glioblastoma

KW - Pseudoprogression

KW - Vascular endothelial growth factor

UR - http://www.scopus.com/inward/record.url?scp=84892601371&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892601371&partnerID=8YFLogxK

U2 - 10.1634/theoncologist.2013-0101

DO - 10.1634/theoncologist.2013-0101

M3 - Article

C2 - 24309981

AN - SCOPUS:84892601371

VL - 19

SP - 75

EP - 81

JO - Oncologist

JF - Oncologist

SN - 1083-7159

IS - 1

ER -