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Issues relative to Tx response evaluation in RCC

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.

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Issues relative to Tx response evaluation in RCC

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  1. Issues relative to Tx response evaluation in RCC Dr. Camillo Porta S.C. di OncologiaMedica I.R.C.C.S. Policlinico San Matteo, Pavia

  2. Weshould take into account that … RCC is an extremelypeculiarcancer in terms of responseevaluation ... ... mainly due to itsuniquemolecularpathogenesis

  3. From biology to the clinic

  4. Peculiarities of targeted agents in terms of MOA ASL MRI H&E stain(2x); CD34 stain (20x) RiniB, Atkins M. Lancet Oncol 2009;10:992-1000

  5. Peculiarities of targeted agents in terms of MOA 10 x 6 cm 11 x 7 cm Abou-Alfa GK, et al. J Clin Oncol 2006;24:4293–300

  6. Peculiarities of targeted agents in terms of MOA Abou-Alfa GK, et al. J Clin Oncol 2006;24:4293–300

  7. Peculiarities of targeted agents in terms of MOA Baseline After 4 weeks of sorafenib therapy Gatzemeier U, et al. ASCO 2006, Atlanta, GA, USA

  8. From biology to the clinic

  9. 18FDG PET and its limitations in RCC RiojaJ, et al. BJU Int2010;106:1578-93

  10. Easy and cost-effective, but … Color-Doppler CEUS to predict PFS Baseline Week 6 Courtesy of Escudier B (ASCO 2005)

  11. Other tracers: Girentuximab (anti-CAIX MoAb) Stillebroer AB, et al. EurUrol2010;58:75-83 Stillebroer AB, et al. Cancer Imaging 2007;7:179-88

  12. Other tracers: Girentuximab (anti-CAIX MoAb)

  13. Some lesions are neither measurable nor easily evaluable Therasse P, et al. J Natl Cancer Inst 2000;24:205–16

  14. The future could be … DynamicContrast-EnhancedMagneticResonanceImaging (DCE-MRI) • Potential: May be used to studymicrovasculardensity, vascularpermeability, extravascular/extracellularspace • Whatweknow: Successfultherapiesresult in changes in DCE-MRI contrast-enhancementparameterswhichmay prove to be accurate and earlyindicators of response Onestudydemonstratedthat DCE-MRI mayactas a sensitive biomarker for response to the VEGFR inhibitor PTK787/ZK2225841 • Pitfalls: High variability of the methodsused for data acquisition and analysislack of a general consensus on how best to acquire and/or analyse data • Onlyconsensusrecommendations are, atpresent, available2 1Morgan B, et al. J Clin Oncol 2003;21:3955–64 2Evelhoc J, et al. NCI Cancer Imaging Program (http://imaging.cancer.gov)

  15. The future could be … • 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 NMRspectra of water in tissues, while MRS detects the resonance spectra ofchemical compounds other than water, allowing for a true depictionof 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

  16. In conclusion … Webadlyneed new responsecriteria for molecularlytargeted agents Also in thisfield, enrollment of patientsintospecificallydesignedstudiesiscrucial

  17. Thank You for Your kind attention!!! c.porta@smatteo.pv.it

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