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Magnetic resonance imaging-derived parameters to predict response to regorafenib in recurrent glioblastoma

  • Diagnostic Neuroradiology
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Abstract

Purpose

Regorafenib is a multikinase inhibitor, approved as a preferred regimen for recurrent glioblastoma (rGB). Although its effects on prolonging survival could seem modest, it is still unclear whether a subset of patients, potentially identifiable by imaging biomarkers, might experience a more substantial positive effect. Our aim was to evaluate the potential value of magnetic resonance imaging-derived parameters as non-invasive biomarkers to predict response to regorafenib in patients with rGB.

Methods

20 patients with rGB underwent conventional and advanced MRI at diagnosis (before surgery), at recurrence and at first follow-up (3 months) during regorafenib. Maximum relative cerebral blood volume (rCBVmax) value, intra-tumoral susceptibility signals (ITSS), apparent diffusion coefficient (ADC) values, and contrast-enhancing tumor volumes were tested for correlation with response to treatment, progression-free survival (PFS), and overall survival (OS). Response at first follow-up was assessed according to Response Assessment in Neuro-Oncology (RANO) criteria.

Results

8/20 patients showed stable disease at first follow-up. rCBVmax values of the primary glioblastoma (before surgery) significantly correlated to treatment response; specifically, patients with stable disease displayed higher rCBVmax compared to progressive disease (p = 0.04, 2-group t test). Moreover, patients with stable disease showed longer PFS (p = 0.02, 2-group t test) and OS (p = 0.04, 2-group t test). ITSS, ADC values, and contrast-enhancing tumor volumes showed no correlation with treatment response, PFS nor OS.

Conclusion

Our results suggest that rCBVmax of the glioblastoma at diagnosis could serve as a non-invasive biomarker of treatment response to regorafenib in patients with rGB.

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Data availability

The data that support the findings of this study are available upon reasonable request.

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. UOSD Neuroradiologia Diagnostica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del S. Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Matia Martucci, Rosellina Russo, Carolina Giordano & Simona Gaudino

  2. Istituto di Radiologia, Università Cattolica del S. Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Andrea Maurizio Ferranti, Francesco Schimperna & Francesca Magnani

  3. UOC Radiologia d’Urgenza, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del S. Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Amato Infante

  4. UOC Neurochirurgia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del S. Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Alessandro Olivi & Quintino Giorgio D’Alessandris

  5. UOS Neuropatologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del S. Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Marco Gessi

  6. UOC Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del S. Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy

    Silvia Chiesa & Ciro Mazzarella

Authors
  1. Matia Martucci
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  2. Andrea Maurizio Ferranti
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  3. Francesco Schimperna
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  4. Amato Infante
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  7. Quintino Giorgio D’Alessandris
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  8. Marco Gessi
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  9. Silvia Chiesa
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  11. Rosellina Russo
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  12. Carolina Giordano
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  13. Simona Gaudino
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Contributions

Conceptualization: Simona Gaudino, Matia Martucci, Silvia Chiesa, and Alessandro Olivi; methodology: Simona Gaudino, Matia Martucci, and Andrea Maurizio Ferranti; formal analysis and investigation: Matia Martucci, Amato Infante, Francesca Magnani, Francesco Schimperna, Silvia Chiesa, and Andrea Maurizio Ferranti; writing—original draft preparation: Matia Martucci, Andrea Maurizio Ferranti, and Amato Infante; writing—review and editing: Simona Gaudino, Matia Martucci, Carolina Giordano, Rosellina Russo, Francesca Magnani, Andrea Maurizio Ferranti, Ciro Mazzarella, Quintino Giorgio D’Alessandris, and Marco Gessi; supervision: Simona Gaudino, Matia Martucci, Silvia Chiesa, and Alessandro Olivi. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Matia Martucci.

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Competing interests

The authors declare no competing interests.

Ethics approval

We declare that all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was waived by the local Ethics Committee of Università Cattolica del Sacro Cuore – Policlinico Universitario “A. Gemelli” in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Informed consent

The requirement for informed consent was officially waived by the IRB of Università Cattolica del Sacro Cuore – Policlinico Universitario “A. Gemelli” due to the purely retrospective nature of the study.

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Martucci, M., Ferranti, A.M., Schimperna, F. et al. Magnetic resonance imaging-derived parameters to predict response to regorafenib in recurrent glioblastoma. Neuroradiology 65, 1439–1445 (2023). https://doi.org/10.1007/s00234-023-03169-y

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