Abstract
Purpose
Resistance to bevacizumab (BEV) in glioblastoma is believed to occur via activation of molecular networks including the mTOR/PI3K pathway. Using an MR/PET molecular imaging biomarker approach, we investigated the response to combining BEV with the mTOR/PI3K inhibitor BEZ235.
Methods
Tumours were established by orthotopically implanting U87MG-luc2 cells in mice. Animals were treated with BEZ235 and/or BEV, and imaged using diffusion-weighted-MRI, T2-weighted and T2*-weighted before and after administration of superparamagnetic iron oxide contrast agent. Maps for changes in relaxation rates (ΔR2, ΔR2* and apparent diffusion coefficient) were calculated. Vessel size index and microvessel density index were derived. 3′-Deoxy-3′-[18F]fluorothymidine ([18F]FLT) PET and O-(2-[18F]fluoroethyl)-l-tyrosine ([18F]FET) PET were further performed and tumour endothelium/proliferation markers assessed by immunohistochemistry.
Results
Treatment with BEV resulted in a pronounced decrease in tumour volume (T2-weighted MRI). No additive effect on tumour volume was observed with the BEV/BEZ235 combination compared with BEV monotherapy. The Ki67 proliferation index and [18F]FLT uptake studies were used to support the observations. Using ΔR2* and ΔR2 values, respectively, the BEV/BEZ235 combination significantly reduced tumour microvessel volume in comparison to BEV alone. Decreased microvessel density index was further observed in animals treated with the combination, supported by von Willebrand factor (vWF) immunohistochemistry. [18F]FET uptake was decreased following treatment with BEV alone, but was not further reduced following treatment with the combination. vWF immunohistochemistry analysis showed that the mean tumour vessel size was increased in all cohorts.
Conclusion
Assessing MR imaging biomarker parameters together with [18F]FET and [18F]FLT PET provided information on mechanism of action of the drug combination and clues as to potential clinical responses. Following translation to clinical use, treatment with a BEV/BEZ235 combination could reduce peritumoral oedema obviating the requirement for steroids. The use of hypothesis-driven molecular imaging studies facilitates the preclinical evaluation of drug response. Studies of this kind may more accurately predict the clinical potential of the BEV/BEZ235 combination regimen as a novel therapeutic approach in oncology.
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Funding
This study was funded by the Euro Bio-Imaging Project and Beaumont Hospital Cancer Research & Development Trust. P.O.H. obtained an award from The Company of Biologists and the Interdisciplinary Centre for Clinical Research Münster (PIX). A.T.B. and J.H.M.P. are funded under the European Union’s Seventh Framework Programme for research, technological development, and demonstration under grant agreement 278981 (AngioPredict). C.F. received funding from the German Research Foundation under grant SFB1009 Z02.
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All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. This article does not describe any studies with human participants performed by any of the authors.
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Philip J. O’Halloran, Thomas Viel and David W. Murray contributed equally to this work.
Andreas H. Jacobs and Annette T. Byrne are joint senior authors.
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Supplementary Figure 1
Correlation between imaging and IHC data. a Correlation between MDI and microvessel density as determined by vWF staining. b Correlation between [18F]FET uptake and microvessel density as determined by vWF staining. c Correlation between MDI and [18F]FET uptake. d Correlation between [18F]FLT uptake and Ki67 index (PDF 143 kb)
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O’Halloran, P.J., Viel, T., Murray, D.W. et al. Mechanistic interrogation of combination bevacizumab/dual PI3K/mTOR inhibitor response in glioblastoma implementing novel MR and PET imaging biomarkers. Eur J Nucl Med Mol Imaging 43, 1673–1683 (2016). https://doi.org/10.1007/s00259-016-3343-3
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DOI: https://doi.org/10.1007/s00259-016-3343-3