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CT and PET: Early Prognostic Indicators of Response to Imatinib Mesylate in Patients with Gastrointestinal Stromal Tumor

Clay H. Holdsworth1,2, Ramsey D. Badawi3, Judith B. Manola2, Marie F. Kijewski4, David A. Israel2,4, George D. Demetri2 and Annick D. Van den Abbeele2,4

1 Massachusetts College of Pharmacy and Health Sciences, 4 Brook Rd., Unit 11, Salem, NH 03079.
2 Dana-Farber Cancer Institute, Boston, MA.
3 University of California Davis School of Medicine, Sacramento, CA.
4 Brigham and Women's Hospital, Boston, MA.


Figure 1
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  		Fig. 1A —Patient with gastrointestinal stromal tumor who responded to imatinib mesylate treatment. Maximum-intensity-projection images obtained before (A) and 1 month after (B) initiation of imatinib mesylate therapy. Metabolic activity in large tumor masses in patient's liver is reduced to normal levels after treatment initiation.

 

Figure 2
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  		Fig. 1B —Patient with gastrointestinal stromal tumor who responded to imatinib mesylate treatment. Maximum-intensity-projection images obtained before (A) and 1 month after (B) initiation of imatinib mesylate therapy. Metabolic activity in large tumor masses in patient's liver is reduced to normal levels after treatment initiation.

 

Figure 3
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  		Fig. 1C —Patient with gastrointestinal stromal tumor who responded to imatinib mesylate treatment. Transaxial 18F-FDG PET images before (C) and 1 month after (D) initiation of imatinib mesylate therapy show that metabolic activity in tumor has decreased to normal levels after treatment.

 

Figure 4
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  		Fig. 1D —Patient with gastrointestinal stromal tumor who responded to imatinib mesylate treatment. Transaxial 18F-FDG PET images before (C) and 1 month after (D) initiation of imatinib mesylate therapy show that metabolic activity in tumor has decreased to normal levels after treatment.

 

Figure 5
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  		Fig. 1E —Patient with gastrointestinal stromal tumor who responded to imatinib mesylate treatment. Transaxial CT images obtained before (E) and 1 month after (F) initiation of imatinib mesylate therapy show that tumor is still present and has decreased very little in size.

 

Figure 6
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  		Fig. 1F —Patient with gastrointestinal stromal tumor who responded to imatinib mesylate treatment. Transaxial CT images obtained before (E) and 1 month after (F) initiation of imatinib mesylate therapy show that tumor is still present and has decreased very little in size.

 

Figure 7
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  		Fig. 2A —Patient with gastrointestinal stromal tumor (GIST) who did not respond to imatinib mesylate treatment. 18F-FDG PET images obtained before (A) and 1 month after (B) initiation of imatinib mesylate show that metabolic activity in tumor has increased and patient's GIST is unresponsive to imatinib mesylate treatment.

 

Figure 8
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  		Fig. 2B —Patient with gastrointestinal stromal tumor (GIST) who did not respond to imatinib mesylate treatment. 18F-FDG PET images obtained before (A) and 1 month after (B) initiation of imatinib mesylate show that metabolic activity in tumor has increased and patient's GIST is unresponsive to imatinib mesylate treatment.

 

Figure 9
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  		Fig. 2C —Patient with gastrointestinal stromal tumor (GIST) who did not respond to imatinib mesylate treatment. Transaxial CT images corresponding to A and B before (C) and 1 month after (D) initiation of imatinib mesylate therapy show two tumors (arrows) on far right side of these images that had tripled in size according to CT bidimensional measurements in 1 month.

 

Figure 10
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  		Fig. 2D —Patient with gastrointestinal stromal tumor (GIST) who did not respond to imatinib mesylate treatment. Transaxial CT images corresponding to A and B before (C) and 1 month after (D) initiation of imatinib mesylate therapy show two tumors (arrows) on far right side of these images that had tripled in size according to CT bidimensional measurements in 1 month.

 

Figure 11
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  		Fig. 3A —Kaplan-Meier plots of population split (n = 58). Plot shows data obtained using optimized threshold of 0% reduction (or lack of growth) in CT bidimensional measurements from baseline to 1 month after initiation of therapy.

 

Figure 12
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  		Fig. 3B —Kaplan-Meier plots of population split (n = 58). Plot shows data obtained using previously determined threshold of 5% reduction [10] in CT bidimensional measurements from baseline to 2 months after initiation of therapy. (p < 0.0001, log-rank statistic)

 

Figure 13
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  		Fig. 4A —Kaplan-Meier plots of population split (n = 58) using different thresholds. Plot shows data obtained using optimized threshold of 40% reduction in maximum standardized uptake value (SUVmax) on 18F-FDG PET from baseline to 1 month after initiation of therapy.

 

Figure 14
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  		Fig. 4B —Kaplan-Meier plots of population split (n = 58) using different thresholds. Plot shows data obtained using optimized FDG PET SUVmax threshold of 3.4 at 1 month after initiation of therapy.

 

Figure 15
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  		Fig. 5 —Time-to-treatment failure (TTF) curves for four populations (n = 58) defined by optimized maximum standardized uptake value (SUVmax) on 18F-FDG PET success and optimized CT bidimensional measurement success, SUVmax failure and CT bidimensional measurement failure, SUVmax success and CT bidimensional measurement failure, and SUVmax failure and CT bidimensional measurement success.

 

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