Issues relative to Tx response evaluation in RCC
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Transcript of Issues relative to Tx response evaluation in RCC
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RCC is an extremely peculiar cancer in terms of response evaluation ...
... mainly due to its unique molecular pathogenesis
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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)
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10 x 6 cm 11 x 7 cm
Abou-Alfa GK, et al. J Clin Oncol 2006;24:4293–300
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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
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After 4 weeks of sorafenib therapyBaseline
Gatzemeier U, et al. ASCO 2006, Atlanta, GA, USA
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Rioja J, et al. BJU Int 2010;106:1578-93Rioja J, et al. BJU Int 2010;106:1578-93
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Color-Doppler CEUS to predict PFSBaseline Week 6
Courtesy of Escudier B (ASCO 2005)
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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
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Therasse P, et al. J Natl Cancer Inst 2000;24:205–16
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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
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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
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We badly need new response criteria for molecularly targeted agents
Also in this field, enrollment of patients into specifically designed studies is crucial