What question did this study set out to answer?

To evaluate QVT Subscore as a source of interpretable insights into vascular mechanisms of action for NSCLC treatment.

April 5, 2026

Abstract 3751: QVT Subscore: An interpretable radiomic panel of tumor vascularity reveals treatment-specific mechanisms-of-action (MoA) in NSCLC

Key Points

To evaluate QVT Subscore as a source of interpretable insights into vascular mechanisms of action for NSCLC treatment.
Derived QVT Subscores by categorizing 910 features of QVT Score into six biological groups.
Evaluated QVT Subscores in a cohort of 557 patients from the SWOG S0819 trial and a real-world ICI cohort of 147 patients.
Assessed changes in QVT Score and Subscores using paired t-tests, stratifying by objective response.
Mono-chemotherapy showed no changes in vascularity, while VEGFi reduced QVT Score with significant decreases in Branch and Curvature Subscores.
ICI recipients exhibited significant increases in QVT Score and 5 out of 6 Subscores, showing opposite changes to VEGFi effects.
For patients achieving objective response, VEGFi led to greater vascular decreases compared to those not achieving response.
ICI patients demonstrated negligible QVT changes in OR but significant increases in non-OR across most subscores.

Abstract

Abstract Background: Tumor angiogenesis drives treatment resistance by fostering an immunosuppressive microenvironment. VEGF inhibitors (VEGFi) target the vasculature, while immune checkpoint inhibitors (ICI) do not address this mechanism directly. Quantitative Vessel Tortuosity (QVT) Score is a radiomic biomarker of vascularity previously shown to be associated with ICI response. Here, we introduce QVT Subscore, an interpretable panel that isolates distinct vascular attributes (e.g., branching, curvature, radius), enabling treatment-specific insight into vascularity MoA and vascular normalization. Methods: QVT Subscores are derived by grouping the 910 QVT features comprising QVT Score into six biological categories, summarized by principal component analysis. The panel was evaluated in 557 patients from the phase 3 SWOG S0819 trial and a real-world ICI monotherapy cohort (n=147). QVT score/subscore changes from baseline to first on-treatment CTs were assessed by paired t-test and substratified by objective response (OR). Results: While the mono-chemotherapy showed no vascularity changes, VEGFi regimens reduced QVT Score, with Branch and Curvature Subscores decreasing significantly but Vessel Volume unchanged. In contrast, ICI recipients exhibited significant increases in QVT Score and 5/6 Subscores, showing opposite changes to VEGFi in four subscores and differing effects on vessel Radius and Volume. VEGFi produced the greatest vascularity decrease in patients achieving OR, with milder decreases in non-OR. For ICI, OR showed negligible QVT change, while vascularity significantly increased in non-OR across all subscores except Radius. Conclusions: The QVT Subscore panel captures granular tumor vascular remodeling from different treatments, providing mechanistically grounded insights into clinical trial arm performance. Future work will assess the panel’s potential for identifying regimens that benefit from adding VEGFi. Citation Format: Haojia Li, Pushkar Mutha, Young Kwang Chae, Kai Zhang, Liam Il-Young Chung, Amogh Hiremath, Rhea Chitalia, Justin Yau, Omid Haji-Maghsoudi, Trishan Arul, Vamsidhar Velcheti, Anant Madabhushi, Nathaniel Braman. QVT Subscore: An interpretable radiomic panel of tumor vascularity reveals treatment-specific mechanisms-of-action (MoA) in NSCLC abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 3751.

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