RCC is an extremely peculiar cancer in terms of response evaluation ...

... mainly due to its unique molecular pathogenesis

Rini B, Atkins M. Lancet Oncol 2009;10:992-1000Rini B, Atkins M. Lancet Oncol 2009;10:992-1000

ASL MRI

H&E stain (2x);

CD34 stain (20x)

10 x 6 cm 11 x 7 cm

Abou-Alfa GK, et al. J Clin Oncol 2006;24:4293–300

Baseline Follow-up 1

Follow-up 2

Volume (cm3)

295 341 285

% necrosis 2.09 53.07 51.03

Abou-Alfa GK, et al. J Clin Oncol 2006;24:4293–300

After 4 weeks of sorafenib therapyBaseline

Gatzemeier U, et al. ASCO 2006, Atlanta, GA, USA

Rioja J, et al. BJU Int 2010;106:1578-93Rioja J, et al. BJU Int 2010;106:1578-93

Color-Doppler CEUS to predict PFSBaseline Week 6

Courtesy of Escudier B (ASCO 2005)

Stillebroer AB, et al. Eur Urol 2010;58:75-83Stillebroer AB, et al. Eur Urol 2010;58:75-83

Stillebroer AB, et al. Cancer Imaging 2007;7:179-88Stillebroer AB, et al. Cancer Imaging 2007;7:179-88

Therasse P, et al. J Natl Cancer Inst 2000;24:205–16

1Morgan B, et al. J Clin Oncol 2003;21:3955–642Evelhoc J, et al. NCI Cancer Imaging Program (http://imaging.cancer.gov)

Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI)

Potential: May be used to study microvascular density, vascular permeability, extravascular/extracellular space

What we know: Successful therapies result in changes in DCE-MRI contrast-enhancement parameters which may prove to

be accurate and early indicators of response

One study demonstrated that DCE-MRI may act as a sensitive biomarker for response to the VEGFR inhibitor PTK787/ZK2225841

Pitfalls: High variability of the methods used for data acquisition and analysis lack of a general consensus on how best to acquire and/or analyse data

Only consensus recommendations are, at present, available2

Magnetic Resonance Spectroscopy (MRS)

What it is: An application of MRI that provides chemical information about specific tissue metabolites

How it works: Conventional MRI detects the NMR spectra of water in tissues, while MRS detects the resonance spectra of

chemical compounds other than water, allowing for a true depiction of in situ chemistry

This is distinctive for many pathological conditions, including cancer, and for different metabolic states

(eg, necrosis) Pitfalls: Expensive

Validated only for brain tumoursLack of standardisation

Increased level of choline and a decreased level of N-acetylaspartate, a pattern indicative of recurrent

glioma and radiation necrosis

We badly need new response criteria for molecularly targeted agents

Also in this field, enrollment of patients into specifically designed studies is crucial

c.porta@smatteo.pv.it