2022 AAPM 64th Annual Meeting
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Session Title: Biomarkers of Response to Radiation and Immune Modulating Therapies for Advanced Cancer Management
Question 1: The use of [18F]-fluoroestradiol to assess regional breast cancer estrogen receptor expression to guide treatment selection is an example of what type of biomarker?
Reference:Sellmyer MA, Lee IK, Mankoff DA. Building the Bridge: Molecular Imaging Biomarkers for 21st Century Cancer Therapies. J Nucl Med. 2021 Aug 26;62(12):1672-6. doi: 10.2967/jnumed.121.262484. Online ahead of print. PMID: 34446450
Choice A:Prognostic Biomarker
Choice B:Predictive Biomarker
Choice C:Response Biomarker
Choice D:Surrogate Endpoint
Question 2: FDG PET/CT is being explored as an imaging biomarker of response to immunotherapy because:
Reference:Patsoukis N, Bardhan K, Chatterjee P, Sari D, Liu B, Bell LN, Karoly ED, Freeman GJ, Petkova V, Seth P, Li L, Boussiotis VA. PD-1 alters T-cell metabolic reprogramming by inhibiting glycolysis and promoting lipolysis and fatty acid oxidation. Nat Commun. 2015 Mar 26;6:6692. doi: 10.1038/ncomms7692. PMID: 25809635; PMCID: PMC4389235.
Choice A:Tumor cells are FDG avid
Choice B:FDG is primarily excreted via the kidneys
Choice C:The brain typically has high FDG uptake
Choice D:Activated immune cells are FDG avid
Question 3: The peak immune response following treatment with anti-PD-1 therapy, as measured by changes in Ki-67+ CD8 T cells in the blood, is seen at:
Reference:Huang AC, Orlowski RJ, Xu X, Mick R, George SM, Yan PK, Manne S, Kraya AA, Wubbenhorst B, Dorfman L, D'Andrea K, Wenz BM, Liu S, Chilukuri L, Kozlov A, Carberry M, Giles L, Kier MW, Quagliarello F, McGettigan S, Kreider K, Annamalai L, Zhao Q, Mogg R, Xu W, Blumenschein WM, Yearley JH, Linette GP, Amaravadi RK, Schuchter LM, Herati RS, Bengsch B, Nathanson KL, Farwell MD, Karakousis GC, Wherry EJ, Mitchell TC. A single dose of neoadjuvant PD-1 blockade predicts clinical outcomes in resectable melanoma. Nat Med. 2019 Mar;25(3):454-461. doi: 10.1038/s41591-019-0357-y. Epub 2019 Feb 25. PMID: 30804515; PMCID: PMC6699626.
Choice A:1 week after starting therapy
Choice B:3 weeks after starting therapy
Choice C:5 weeks after starting therapy
Choice D:8 weeks after starting therapy
Question 4: Which of the following criteria are relevant for evaluating the quality of a radiomics study:
Reference:Lambin P, Leijenaar RTH, Deist TM, Peerlings J, de Jong EEC, van Timmeren J, Sanduleanu S, Larue RTHM, Even AJG, Jochems A, van Wijk Y, Woodruff H, van Soest J, Lustberg T, Roelofs E, van Elmpt W, Dekker A, Mottaghy FM, Wildberger JE, Walsh S. Radiomics: the bridge between medical imaging and personalized medicine. Nat Rev Clin Oncol. 2017 Dec;14(12):749-762. doi: 10.1038/nrclinonc.2017.141. Epub 2017 Oct 4. PMID: 28975929.
Choice A:Using radiomic features robust to technical factors
Choice B:Assessing the biological correlates of radiomic features
Choice C:Performing external validation in independent datasets
Choice D:All of the above
Question 5: Which of the following is NOT an approach for molecular imaging of the immune system and immune responses:
Reference:McCracken MN, Tavaré R, Witte ON, Wu AM. Advances in PET Detection of the Antitumor T Cell Response. Adv Immunol. 2016;131:187-231. doi: 10.1016/bs.ai.2016.02.004. Epub 2016 Apr 5. PMID: 27235684; PMCID: PMC5880626.
Choice A:Assessing Granzyme B activity using a radiolabeled peptide analog
Choice B:Introducing a reporter gene into therapeutic CAR-T cells for in vivo tracking
Choice C:Mapping brain activity using fMRI
Choice D:Radiolabeling a therapeutic checkpoint inhibitor antibody with Zr-89 for PET
Question 6: CD8 PET imaging can reveal:
Reference:Farwell MD, Gamache RF, Babazada H, Hellmann MD, Harding JJ, Korn R, Mascioni A, Le W, Wilson I, Gordon MS, Wu AM, Ulaner GA, Wolchok JD, Postow MA, Pandit-Taskar N. CD8-Targeted PET Imaging of Tumor-Infiltrating T Cells in Patients with Cancer: A Phase I First-in-Humans Study of 89Zr-Df-IAB22M2C, a Radiolabeled Anti-CD8 Minibody. J Nucl Med. 2022 May;63(5):720-726. doi: 10.2967/jnumed.121.262485. Epub 2021 Aug 19. PMID: 34413145.
Choice A:CD8 lymphocytes in normal lymphoid tissues (spleen, lymph nodes, bone marrow)
Choice B:Presence or absence of CD8 lymphocytes in tumors prior to therapy
Choice C:Changes in CD8 lymphocytes in tumors following immunotherapy
Choice D:All of the above
Question 7: PD-L1 is:
Reference:Lu S, Stein JE, Rimm DL, Wang DW, Bell JM, Johnson DB, Sosman JA, Schalper KA, Anders RA, Wang H, Hoyt C, Pardoll DM, Danilova L, Taube JM. Comparison of Biomarker Modalities for Predicting Response to PD-1/PD-L1 Checkpoint Blockade: A Systematic Review and Meta-analysis. JAMA Oncol. 2019 Aug 1;5(8):1195-1204. doi: 10.1001/jamaoncol.2019.1549. PMID: 31318407; PMCID: PMC6646995.
Choice A:A ligand of the PD-1 receptor expressed in tumors and mediating immune evasion
Choice B:A co-ligand of PD-L2
Choice C:A protein marker highly expressed in regulatory T-cells (Tregs)
Choice D:Involved in antigen presentation
Question 8: Tumor mutational burden is:
Reference:Rizvi H, Sanchez-Vega F, La K, Chatila W, Jonsson P, Halpenny D, Plodkowski A, Long N, Sauter JL, Rekhtman N, Hollmann T, Schalper KA, Gainor JF, Shen R, Ni A, Arbour KC, Merghoub T, Wolchok J, Snyder A, Chaft JE, Kris MG, Rudin CM, Socci ND, Berger MF, Taylor BS, Zehir A, Solit DB, Arcila ME, Ladanyi M, Riely GJ, Schultz N, Hellmann MD. Molecular Determinants of Response to Anti-Programmed Cell Death (PD)-1 and Anti-Programmed Death-Ligand 1 (PD-L1) Blockade in Patients With Non-Small-Cell Lung Cancer Profiled With Targeted Next-Generation Sequencing. J Clin Oncol. 2018 Mar 1;36(7):633-641. doi: 10.1200/JCO.2017.75.3384. Epub 2018 Jan 16. PMID: 29337640
Choice A:The volume of tumor cells measured by radiology
Choice B:The number of synonymous mutations in a given tumor
Choice C:The number of nonsynonymous mutations in a tumor and is commonly expressed as mutations/megabase
Choice D:Mediates resistance to immunotherapy
Question 9: Blood biomarkers AND quantitative imaging share this advantage over tissue markers:
Reference:Dall'Olio FG, Marabelle A, Caramella C, Garcia C, Aldea M, Chaput N, Robert C, Besse B. Tumour burden and efficacy of immune-checkpoint inhibitors. Nat Rev Clin Oncol. 2022 Feb;19(2):75-90. doi: 10.1038/s41571-021-00564-3. Epub 2021 Oct 12. PMID: 34642484.
Choice A:Impart spatial information for treatment targeting
Choice B:Identify cancer driver mutations for treatment selection
Choice C:Provide minimally invasive longitudinal data for treatment monitoring
Choice D:Do not require pre-processing or post-processing methods
Question 10: Which imaging and blood biomarkers are being investigated for the assessment of response to chemoimmunotherapy and radiation therapy:
Reference:Bowen SR, Hippe DS, Thomas HM, Sasidharan B, Lampe PD, Baik CS, Eaton KD, Lee S, Martins RG, Santana-Davila R, Chen DL, Kinahan PE, Miyaoka RS, Vesselle HJ, Houghton AM, Rengan R, Zeng J. Prognostic Value of Early Fluorodeoxyglucose-Positron Emission Tomography Response Imaging and Peripheral Immunologic Biomarkers: Substudy of a Phase II Trial of Risk-Adaptive Chemoradiation for Unresectable Non-Small Cell Lung Cancer. Adv Radiat Oncol. 2021 Nov 21;7(2):100857. doi: 10.1016/j.adro.2021.100857. PMID: 35387421; PMCID: PMC8977846.
Choice A:Total lesion glycolysis.
Choice B:Metabolic tumor volume.
Choice C:Peripheral blood T-cell receptor diversity and functionality.
Choice D:Neutrophil-to-lymphocyte ratio.
Choice E:All of the above.
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