In a single-institution study reported in the Journal of Immunotherapy and Precision Oncology, Xu et al found that the use of a Web-based lesion selection tool (LST) developed by the research team improved consistency in lesion selection for sequential biopsy. In addition, the tool improved the rate of collection of at least five cores per biopsy compared with standard practice in patients with cancer.
Study Details
The study included 145 patients at The University of Texas MD Anderson Cancer Center, with the LST being used for 88 patients and 57 patients serving as controls. The LST process consisted of six steps:
(1) An oncology team member used the LST to submit a request to diagnostic radiology to select measurable lesions from the most recent imaging of a patient.
(2) A diagnostic radiologist selected measurable lesions, with automated e-mail notification sent to the interventional radiology and radiation oncology departments (if applicable).
(3) An interventional radiologist selected lesions suitable for a biopsy specimen, and a radiation oncologist selected lesions suitable for radiotherapy; an automated e-mail notification was sent to the oncology team after lesion selection.
(4) An oncologist reviewed the selections and determined the final lesion assignment, which was communicated by automated e-mail to individual collaborators; this lesion selection was maintained for the duration of treatment.
(5) Based on the oncologist’s determination, an oncology team member submitted a request to interventional radiology specifying the lesion to be biopsied, a request to diagnostic radiology specifying lesions for tumor measurement, and a request to radiation oncology specifying the lesion to be irradiated (if applicable).
(6) Based on lesion assignment, a biopsy was performed by an interventional radiologist, tumor measurement by a diagnostic radiologist, and radiation by a radiation oncologist (if applicable).
All information regarding lesion selection and final assignment was recorded in the LST and was readily accessible to all authorized collaborators.
The novel LST platform facilitates coordination, performance, and management of longitudinal biopsy specimens. Use of the LST enables sampling of the designated lesion consistently, which is likely to accurately inform us [of] the effect of the treatment on tumor microenvironment and evolution of resistant pathways.— Xu et al
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Key Findings
Of 88 patients in the LST group, 30 (34%) completed the LST process, received treatment, and underwent baseline biopsy. Of 57 patients in the control group, 52 (91%) received treatment and underwent baseline biopsy.
Longitudinal biopsy collection occurred for 24 of 30 patients in the LST group and all 52 patients in the control group. The same designated lesion was biopsied at baseline and at subsequent time points in all 24 patients (100%) in the LST group, compared with 39 (75%) of 52 control group patients (P = .007). At least five cores per biopsy were collected in 25 (83%) of 30 LST group patients vs 14 (27%) of 52 control group patients at baseline (P < .001), in 21 (88%) of 24 vs 17 (33%) of 52 at the on-treatment-1 time point (P < .001), and in 8 (89%) of 9 vs 0 (0%) of 2 at the on-treatment-2 time point (P = .055).
Assessment of cores with adequate cellularity for next-generation sequencing (NGS) included 211 cores in the LST group (110 baseline cores from 25 patients, 77 on-treatment-1 cores from 17 patients, and 24 on-treatment-2 cores from 5 patients) and 349 from the control group (168 baseline cores from 52 patients, 176 on-treatment-1 cores from 52 patients, and 5 on-treatment-2 cores from 2 patients). No significant difference was observed between groups in proportions of patients with at least one core with adequate tumor cellularity for NGS: proportions were 60% vs 56% at baseline (P = .81), 41% vs 48% at on-treatment-1 time point (P = .78), and 60% vs 0% at on-treatment-2 time point (P = .43).
The investigators concluded, “The novel LST platform facilitates coordination, performance, and management of longitudinal biopsy specimens. Use of the LST enables sampling of the designated lesion consistently, which is likely to accurately inform us [of] the effect of the treatment on tumor microenvironment and evolution of resistant pathways. Such studies are [an] important translational component of any clinical trials and research as they guide the development of next line of therapy, which has significant effect on clinical utility. However, validation of this approach in a larger study is warranted.”
Mingxuan Xu, PhD, of the Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, is the corresponding author for the Journal of Immunotherapy and Precision Oncology article.
Disclosure: The study was supported by the National Cancer Institute. For full disclosures of the study authors, visit meridian.allenpress.com.
