Imaging-guided prognostic score-based approach to assess the benefits of combotherapy versus monotherapy with immune checkpoint inhibitors in metastatic MSI-H colorectal cancer patients

• DOI: 10.1016/j.ejca.2024.114020
• Publication Date: 2024-03-16T07:10:56Z
• Authors: Rémy Barbe; Younes Belkouchi; Yves Menu; Romain Cohen; Clemence David; Michele Kind; Sana Harguem; Lama Dawi; Joya Hadchiti; Fatine Selhane; Nicolas Billet; Samy Ammari; Ambroise Bertin; Littisha Lawrance; Baptiste Cervantes; Antoine Hollebecque; Corinne Balleyguier; Paul-Henry Cournede; Hugues Talbot; Nathalie Lassau; Thierry Andre
• Keywords: [INFO.INFO-CV] Computer Science [cs]/Computer Vision and Pattern Recognition [cs.CV]; [STAT.ML]Statistics [stat]/Machine Learning [stat.ML]; [SDV.CAN] Life Sciences [q-bio]/Cancer; [INFO.INFO-IM]Computer Science [cs]/Medical Imaging; [INFO.INFO-IM] Computer Science [cs]/Medical Imaging; [INFO.INFO-CV]Computer Science [cs]/Computer Vision and Pattern Recognition [cs.CV]; [SDV.CAN]Life Sciences [q-bio]/Cancer; [STAT.ML] Statistics [stat]/Machine Learning [stat.ML]

This retrospective study determined survival responses to immune checkpoint inhibitors (ICIs), comparing mono- (mono) and combo-immunotherapy (combo) in patients with microsatellite instability-high (MSI-H) metastatic colorectal cancer (mCRC) by analyzing quantitative imaging data and clinical factors.One hundred fifty patients were included from two centers and divided into training (n = 105) and validation (n = 45) cohorts. Radiologists manually annotated chest-abdomen-pelvis computed tomography and calculated tumor burden. Progression-free survival (PFS) was assessed, and variables were selected through Recursive Feature Elimination. Cutoff values were determined using maximally selected rank statistics to binarize features, forming a risk score with hazard ratio-derived weights.In total, 2258 lesions were annotated with excellent reproducibility. Key variables in the training cohort included: total tumor volume (cutoff: 73 cm3), lesion count (cutoff: 20), age (cutoff: 60) and the presence of peritoneal carcinomatosis. Their respective weights were 1.13, 0.96, 0.91, and 0.38, resulting in a risk score cutoff of 1.36. Low-score patients showed similar overall survival and PFS regardless of treatment, while those with a high-score had significantly worse survivals with mono vs combo (P = 0.004 and P = 0.0001). In the validation set, low-score patients exhibited no significant difference in overall survival and PFS with mono or combo. However, patients with a high-score had worse PFS with mono (P = 0.046).A score based on total tumor volume, lesion count, the presence of peritoneal carcinomatosis, and age can guide MSI-H mCRC treatment decisions, allowing oncologists to identify suitable candidates for mono and combo ICI therapies.