Dynamic contrast-enhanced MRI detects responses to stroma-directed therapy in mouse models of pancreatic ductal adenocarcinoma

Purpose: The dense stroma underlies the drug resistance of pancreatic ductal adenocarcinoma (PDA) and has motivated the development of stroma-directed drugs. Our objective is to test the concept that dynamic contrast-enhanced (DCE) MRI using FDA-approved contrast media, an imaging method sensitive to the tumor microenvironment, can detect early responses to stroma-directed drug. Experimental Design: Imaging studies were performed in three mouse models exhibiting high desmoplastic reactions: the autochthonous PDA in genetically engineered mice (KPC), an orthotopic model in syngeneic mice and a xenograft model of human PDA in athymic mice. An investigational drug, PEGPH20 (pegvorhyaluronidase alfa), which degrades hyaluronan in the stroma of PDA, was injected alone or in combination with gemcitabine. Results: At 24 hours after a single injection of PEGPH20, Ktrans, a DCE MRI derived marker that measures how fast a unit volume of contrast media is transferred from capillaries to interstitial space, increased 56% and 50% from baseline in the orthotopic and xenograft tumors respectively, compared to a 4% and 6% decrease in vehicle groups (both P<0.05). Similarly, after three combined treatments, Ktrans in KPC mice increased 54% while it decreased 4% in controls treated with gemcitabine alone (P<0.05). Consistently, after a single injection of PEGPH20, tumor hyaluronan content assessed by immunohistochemistry, was reduced substantially in all three models while drug delivery (measured by paclitaxel accumulation in tumor) was increased by 2.6-fold. Conclusions: These data demonstrated a DCE-MRI marker, Ktrans, can detect early responses to stroma-directed drug and reveal the sustained effect of combination treatment (PEGPH20+ gemcitabine).

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