Qualification of a Noninvasive Magnetic Resonance Imaging Biomarker to Assess Tumor Oxygenation

Purpose: Although hypoxia has been long recognized as a crucial factor impairing tumor response in many therapeutic schemes, atraumatic and reliable methods of individually quantifying tumor oxygenation are still lacking in day-to-day clinical practice. The aim of this work was to investigate the potentially quantitative properties of our recently described noninvasive magnetic resonance (MR) technique “MOBILE” (mapping of oxygen by imaging lipids relaxation enhancement) and to qualify this endogenous contrast as a tumor hypoxia marker. Experimental Design: The “MOBILE” technique, which assesses the longitudinal MR relaxation rate, R1, of lipid protons, was benchmarked with the parent technique which assesses the global (or water) R1, in response to a hyperoxic challenge (carbogen breathing) and to a hypoxic challenge (combretastatin A4) in MDA-MB-231 xenografts and in NT2 mammary tumors. Electron paramagnetic resonance (EPR) oximetry was used to quantitatively assess the tumor pO2 in matching tumors longitudinally. Results and Conclusion: Our study evidenced that (i) positive and negative changes in tumor oxygenation can be detected using MOBILE; (ii) a change in the R1 of lipids is positively correlated with a change in the tumor pO2 (P = 0.0217, r = 0.5097); (iii) measured lipid R1 values are positively correlated with absolute pO2 values in both tumor models (P = 0.0275, r = 0.3726); and (iv) changes in the R1 of lipids are more sensitive than changes in the global R1. As this technique presents unique translational properties, it seems promising for the individual longitudinal monitoring of tumor oxygenation in a clinical setting. Clin Cancer Res; 20(21); 5403–11. ©2014 AACR.

[1]  Kiran Gurung,et al.  Mechanisms of tumor resistance to small-molecule vascular disrupting agents: treatment and rationale of combination therapy. , 2013, Journal of the Formosan Medical Association = Taiwan yi zhi.

[2]  Fiona A. Stewart,et al.  Strategies to improve radiotherapy with targeted drugs , 2011, Nature Reviews Cancer.

[3]  C. Baudelet,et al.  Effect of anesthesia on the signal intensity in tumors using BOLD-MRI: comparison with flow measurements by Laser Doppler flowmetry and oxygen measurements by luminescence-based probes. , 2004, Magnetic resonance imaging.

[4]  S. Beriwal,et al.  Upfront treatment of locally advanced cervical cancer with intensity modulated radiation therapy compared to four-field radiation therapy: a cost-effectiveness analysis. , 2013, Gynecologic oncology.

[5]  Anwar R. Padhani,et al.  Perfusion MRI in the early clinical development of antivascular drugs: decorations or decision making tools? , 2010, European Journal of Nuclear Medicine and Molecular Imaging.

[6]  Shingo Matsumoto,et al.  Simultaneous imaging of tumor oxygenation and microvascular permeability using Overhauser enhanced MRI , 2009, Proceedings of the National Academy of Sciences.

[7]  A. Harris,et al.  New strategies for targeting the hypoxic tumour microenvironment in breast cancer. , 2013, Cancer treatment reviews.

[8]  C. Hess,et al.  Global and health-related quality of life after intensity-modulated radiation therapy for head and neck cancer , 2012, Expert review of anticancer therapy.

[9]  Bernard Gallez,et al.  Assessment of tumor oxygenation by electron paramagnetic resonance: principles and applications , 2004, NMR in biomedicine.

[10]  B. Gallez,et al.  Surrogate MR markers of response to chemo- or radiotherapy in association with co-treatments: a retrospective analysis of multi-modal studies. , 2010, Contrast Media & Molecular Imaging.

[11]  F. Howe,et al.  Evaluation and immunohistochemical qualification of carbogen-induced ΔR₂ as a noninvasive imaging biomarker of improved tumor oxygenation. , 2013, International journal of radiation oncology, biology, physics.

[12]  J. Magat,et al.  Application of MOBILE (mapping of oxygen by imaging lipids relaxation enhancement) to study variations in tumor oxygenation. , 2013, Advances in experimental medicine and biology.

[13]  P. López-Larrubia,et al.  Imaging tumor hypoxia by magnetic resonance methods , 2011, NMR in Biomedicine.

[14]  B. Rini The Context of Blood Vessels and Response to VEGF-Targeted Therapy , 2013, Clinical Cancer Research.

[15]  A. Harris,et al.  Phase I Trial of Combretastatin A4 Phosphate (CA4P) in Combination with Bevacizumab in Patients with Advanced Cancer , 2012, Clinical Cancer Research.

[16]  M. Horsman,et al.  Induction of hypoxia by vascular disrupting agents and the significance for their combination with radiation therapy , 2013, Acta oncologica.

[17]  R. Sharma Nitroimidazole radiopharmaceuticals in bioimaging: part I: synthesis and imaging applications. , 2011, Current Radiopharmaceuticals.

[18]  P Vaupel,et al.  Biological consequences of tumor hypoxia. , 2001, Seminars in oncology.

[19]  James L Tatum,et al.  Hypoxia: Importance in tumor biology, noninvasive measurement by imaging, and value of its measurement in the management of cancer therapy , 2006, International journal of radiation biology.

[20]  Uwe Himmelreich,et al.  Mapping of oxygen by imaging lipids relaxation enhancement: A potential sensitive endogenous MRI contrast to map variations in tissue oxygenation , 2013, Magnetic resonance in medicine.

[21]  Jens Overgaard,et al.  Hypoxic radiosensitization: adored and ignored. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  H. Schild,et al.  Dynamic and simultaneous MR measurement of R1 and R2* changes during respiratory challenges for the assessment of blood and tissue oxygenation , 2013, Magnetic resonance in medicine.

[23]  Johannes H Kaanders,et al.  Accelerated radiotherapy with carbogen and nicotinamide for laryngeal cancer: results of a phase III randomized trial. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  J R Griffiths,et al.  Issues in flow and oxygenation dependent contrast (FLOOD) imaging of tumours , 2001, NMR in biomedicine.

[25]  S. Ogawa Brain magnetic resonance imaging with contrast-dependent oxygenation , 1990 .

[26]  M. Salgaller American Association for Cancer Research , 2000, Expert opinion on investigational drugs.

[27]  J. Magat,et al.  In vivo mapping of tumor oxygen consumption using 19F MRI relaxometry , 2011, NMR in biomedicine.

[28]  P C Lauterbur,et al.  Paramagnetic contrast agents in nuclear magnetic resonance medical imaging. , 1983, Seminars in nuclear medicine.

[29]  Azza B El-Remessy,et al.  Angiogenesis inhibitors in cancer therapy: mechanistic perspective on classification and treatment rationales , 2013, British journal of pharmacology.

[30]  S. Kaye,et al.  Combining Antiangiogenics to Overcome Resistance: Rationale and Clinical Experience , 2012, Clinical Cancer Research.

[31]  Geoff J M Parker,et al.  Organ‐specific effects of oxygen and carbogen gas inhalation on tissue longitudinal relaxation times , 2007, Magnetic resonance in medicine.

[32]  A. Tolcher,et al.  Phase I Safety, Pharmacokinetic and Pharmacodynamic Evaluation of the Vascular Disrupting Agent Ombrabulin (AVE8062) in Patients with Advanced Solid Tumors , 2013, Clinical Cancer Research.

[33]  L. D. McPhail,et al.  Intrinsic susceptibility MR imaging of chemically induced rat mammary tumors: relationship to histologic assessment of hypoxia and fibrosis. , 2010, Radiology.

[34]  A. Zygogianni,et al.  The Treatment Outcome and Radiation-Induced Toxicity for Patients with Head and Neck Carcinoma in the IMRT Era: A Systematic Review with Dosimetric and Clinical Parameters , 2013, BioMed research international.

[35]  P. Lambin,et al.  Taking advantage of tumor cell adaptations to hypoxia for developing new tumor markers and treatment strategies , 2009, Journal of enzyme inhibition and medicinal chemistry.

[36]  Timothy Solberg,et al.  Correlations of noninvasive BOLD and TOLD MRI with pO2 and relevance to tumor radiation response , 2014, Magnetic resonance in medicine.

[37]  Claudiu T. Supuran,et al.  Interfering with pH regulation in tumours as a therapeutic strategy , 2011, Nature Reviews Drug Discovery.

[38]  D. Tank,et al.  Brain magnetic resonance imaging with contrast dependent on blood oxygenation. , 1990, Proceedings of the National Academy of Sciences of the United States of America.

[39]  Geoff J M Parker,et al.  Preliminary study of oxygen-enhanced longitudinal relaxation in MRI: a potential novel biomarker of oxygenation changes in solid tumors. , 2009, International journal of radiation oncology, biology, physics.

[40]  J. Bussink,et al.  Combretastatin A-4 Phosphate Affects Tumor Vessel Volume and Size Distribution as Assessed Using MRI-Based Vessel Size Imaging , 2012, Clinical Cancer Research.

[41]  M. Alber,et al.  Imaging oxygenation of human tumours , 2006, European Radiology.

[42]  M. Mita,et al.  Vascular-disrupting agents in oncology , 2013, Expert opinion on investigational drugs.

[43]  Bernard Gallez,et al.  How does blood oxygen level‐dependent (BOLD) contrast correlate with oxygen partial pressure (pO2) inside tumors? , 2002, Magnetic resonance in medicine.

[44]  G. Jayson,et al.  Do Imaging Biomarkers Relate to Outcome in Patients Treated with VEGF Inhibitors? , 2012, Clinical Cancer Research.

[45]  H. Cheng,et al.  Normal tissue quantitative T1 and T2* MRI relaxation time responses to hypercapnic and hyperoxic gases. , 2011, Academic radiology.

[46]  J. Petersen,et al.  Imaging hypoxia to improve radiotherapy outcome , 2012, Nature Reviews Clinical Oncology.

[47]  V. Grégoire,et al.  Thalidomide radiosensitizes tumors through early changes in the tumor microenvironment. , 2005, Clinical cancer research : an official journal of the American Association for Cancer Research.

[48]  S. Hahn,et al.  Hypoxia imaging markers and applications for radiation treatment planning. , 2012, Seminars in nuclear medicine.

[49]  S. Halford,et al.  Phase I Clinical and Pharmacokinetic Evaluation of the Vascular-Disrupting Agent OXi4503 in Patients with Advanced Solid Tumors , 2012, Clinical Cancer Research.

[50]  J. Waterton,et al.  Exploring ΔR2* and ΔR1 as imaging biomarkers of tumor oxygenation , 2013, Journal of magnetic resonance imaging : JMRI.

[51]  Ralph P. Mason,et al.  Non‐Invasive Physiology and Pharmacology Using 19F Magnetic Resonance , 2008 .