Effectiveness of an image response assessment team (IRAT) approach to advance imaging biomarker inclusion in cancer therapy trials

Objectives Imaging biomarker assessment for early response outcome measures in cancer therapy trials has become a significant priority for patient management decisions and research. Molecular imaging using PET has an important role in this assessment. A major barrier to overcome is the lack of early and effective interaction between oncologists and nuclear medicine (NM) physicians for selection of appropriate imaging modality and proper design of imaging protocols. Over the past three years the University of Pittsburgh has developed an organizational structure for providing IRAT recommendations on imaging utilization in cancer therapy trials. The goal of this study is to evaluate the effectiveness of this structure.

Methods Cancer disease sites were categorized in terms of lung, breast, melanoma, hematological, Head & Neck (HN), GI, GU, CNS, and OB/GYN. Cancer therapy trials were monitored for appropriate utilization of imaging modality and inclusion of a NM physician during cancer imaging trial design before and after IRAT implementation. Image utilization growth was measured by increases in PET imaging in cancer therapy trials. Interaction growth between oncologists and NM physicians was measured by increases in the inclusion of NM physicians in the initial design of cancer therapy trials.

Results PET utilization on cancer therapy trials in CNS, GI, lymphoma, lung, GU, GYN, and breast increased from zero to 3, 2, 3, 3, 4, 2, and 1. PET utilization in HN increased from 1 to 9 and in melanoma from 2 to 4. The NM physician inclusion on trial design increased from one to 1, 3, 3, 1, 1 on GI, HN, lung, melanoma, and breast (total increase from 1 to 9).

Conclusions An administrative structure to provide IRAT recommendations on cancer therapy trials significantly enhances oncologist awareness of the value of imaging and increases the use of PET imaging biomarker assessment in cancer therapy trials.

Research Support NIH P30 CA04790