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

Rémy Barbe, Younes Belkouchi, Yves Menu, Romain Cohen, Clemence David, Michele Kind, Sana Harguem, Lama Dawi, Joya Hadchiti, Fatine Selhane, Nicolas Billet, Samy Ammari, Ambroise Bertin, Littisha Lawrance, Baptiste Cervantes, Antoine Hollebecque, Corinne Balleyguier, Paul Henry Cournede, Hugues Talbot, Nathalie LassauThierry Andre

    Résultats de recherche: Contribution à un journalArticleRevue par des pairs

    Résumé

    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.

    langue originaleAnglais
    Numéro d'article114020
    journalEuropean Journal of Cancer
    Volume202
    Les DOIs
    étatPublié - 1 mai 2024

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