Dr. Brunner on the Utilization of Advanced Imaging Modalities in R/R Multiple Myeloma

Matthew Brunner, MD, assistant professor, hematologic specialist, medical oncology, and palliative care, Department of Medicine, University of Wisconsin Carbone Cancer Center, discusses how to best approach the navigation of advanced imaging modalities in relapsed/refractory multiple myeloma.

The increasing use of advanced imaging techniques has expanded treatment selection in relapsed/refractory multiple myeloma, Brunner begins. Several studies have investigated the comparative utility of novel vs standard techniques in this space, including the phase 3 IMAJEM trial (NCT01309334), Brunner details. This prospective trial compared the efficacy of MRI imaging vs [18F]Fluorodeoxyglucose PET computed tomography (CT) scans with respect to their detection of bone lesions at diagnosis, as well as their ability to predict patient response to subsequent maintenance therapy. There was no difference in the detection of bone lesions at diagnosis when comparing PET-CT and MRI, indicating that both options are effective and comparable, Brunner states. However, PET-CT was shown to have substantial prognostic value.

PET-CT imaging is the current imaging standard of care (SOC) for patients with relapsed/refractory multiple myeloma due to its ability to detect extramedullary disease and PET-avid disease, Brunner continues. Both features are highly prevalent in this disease space, he notes. Additionally, PET-CTimaging can be utilized as a marker of patient responses during treatment. Tracking improvements in imaging can add to or supplement other common indicators of response such as serologic markers, biomarkers, and decreased anemia, Brunner says.

Conversely, MRI functional imaging has evolved to utilize diffusion weighting, and novel PET-MRI scans are also an option, Brunner states. This modality is more sensitive in certain applications and can provide a better anatomic picture, he explains. Patients who may have structural issues and need radiation or surgery are more easily identified with this technique, Brunner adds.

In terms of prognostic value, PET-CT scans can predict a patient's likelihood of late-line relapse, Brunner says. Moreover, PET-CT scans can help identify key patient characteristics that are associated with benefit from a given treatment, in turn, informing treatment selection, he states. This includes factors such as a high-risk, asymptomatic lesion, which would require immediate radiation or surgical fixation before treatment could be initiated, Brunner concludes.