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Response evaluation in RCC Dr. Camillo Porta S.C. di Oncologia Medica I.R.C.C.S. Policlinico San Matteo, Pavia
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We should take into account that … RCC is an extremely peculiar cancer in terms of response evaluation...... mainly due to its unique molecular pathogenesis
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From biology to the clinic
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Peculiarities of targeted agents in terms of MOA Rini 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 Peculiarities of targeted agents in terms of MOA
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BaselineFollow-up 1Follow-up 2 Volume (cm3)295341285 % necrosis2.0953.0751.03 Abou-Alfa GK, et al. J Clin Oncol 2006;24:4293–300 Peculiarities of targeted agents in terms of MOA
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After 4 weeks of sorafenib therapyBaseline Gatzemeier U, et al. ASCO 2006, Atlanta, GA, USA Peculiarities of targeted agents in terms of MOA
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From biology to the clinic
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18FDG PET and its limitations in RCC Rioja J, et al. BJU Int 2010;106:1578-93
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Easy and cost-effective, but … Color-Doppler CEUS to predict PFS Baseline Week 6 Courtesy of Escudier B (ASCO 2005)
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Other tracers: Girentuximab (anti-CAIX MoAb) Stillebroer AB, et al. Eur Urol 2010;58:75-83 Stillebroer AB, et al. Cancer Imaging 2007;7:179-88
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Other tracers: Girentuximab (anti-CAIX MoAb)
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Some lesions are neither measurable nor easily evaluable Therasse P, et al. J Natl Cancer Inst 2000;24:205–16
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1Morgan B, et al. J Clin Oncol 2003;21:3955–64 2Evelhoc 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 The future could be …
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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 tumours Lack of standardisation Increased level of choline and a decreased level of N-acetylaspartate, a pattern indicative of recurrent glioma and radiation necrosis The future could be …
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In conclusion … We badly need new response criteria for molecularly targeted agents Also in this field, enrollment of patients into specifically designed studies is crucial
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Thank You for Your kind attention!!! c.porta@smatteo.pv.it
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