TY - JOUR
T1 - 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
AU - Barbe, Rémy
AU - Belkouchi, Younes
AU - Menu, Yves
AU - Cohen, Romain
AU - David, Clemence
AU - Kind, Michele
AU - Harguem, Sana
AU - Dawi, Lama
AU - Hadchiti, Joya
AU - Selhane, Fatine
AU - Billet, Nicolas
AU - Ammari, Samy
AU - Bertin, Ambroise
AU - Lawrance, Littisha
AU - Cervantes, Baptiste
AU - Hollebecque, Antoine
AU - Balleyguier, Corinne
AU - Cournede, Paul Henry
AU - Talbot, Hugues
AU - Lassau, Nathalie
AU - Andre, Thierry
N1 - Publisher Copyright:
© 2024 Elsevier Ltd
PY - 2024/5/1
Y1 - 2024/5/1
N2 - 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.
AB - 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.
KW - Combo-immunotherapy
KW - Immune checkpoint inhibitors
KW - Metastatic colorectal cancer
KW - Microsatellite instability high
KW - Mono-immunotherapy
KW - Overall survival
KW - Progression-free survival
KW - Total Tumor Volume
UR - http://www.scopus.com/inward/record.url?scp=85188459848&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2024.114020
DO - 10.1016/j.ejca.2024.114020
M3 - Article
AN - SCOPUS:85188459848
SN - 0959-8049
VL - 202
JO - European Journal of Cancer
JF - European Journal of Cancer
M1 - 114020
ER -