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Issues relative to Tx response evaluation in RCC. Dr. Camillo Porta S.C. di Oncologia Medica I.R.C.C.S. Policlinico San Matteo , Pavia. We should take into account that …. RCC is an extremely peculiar cancer in terms of response evaluation. - PowerPoint PPT Presentation
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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