2. Tx response evaluation in RCC I.R.C.C.S. Policlinico San Matteo, Pavia
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

3. take into account that …
We should
take into account that …
RCC is an extremely peculiar cancer in terms of response evaluation ...
... mainly due to its unique molecular pathogenesis

4. From biology to the clinic

5. Peculiarities of targeted agents
in terms of MOA
ASL MRI
H&E stain (2x);
CD34 stain (20x)
Rini B, Atkins M. Lancet Oncol 2009;10:

6. 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

7. Peculiarities of targeted agents
in terms of MOA
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

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

9. From biology to the clinic

10. 18FDG PET and its limitations in RCC
Rioja J, et al. BJU Int 2010;106:

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

12. Girentuximab (anti-CAIX MoAb)
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

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

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

15. The future could be …
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/ZK
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
1Morgan B, et al. J Clin Oncol 2003;21:3955–64
2Evelhoc J, et al. NCI Cancer Imaging Program (

16. 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 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

17. 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

18. Thank You for Your kind attention!!!