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Metastatic renal cell carcinoma imaging evaluation in the era of anti-angiogenic therapies

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Abstract

During the last decade, the arsenal of anti-angiogenic (AAG) agents used to treat metastatic renal cell carcinoma (RCC) has grown and revolutionized the treatment of metastatic RCC, leading to improved overall survival compared to conventional chemotherapy and traditional immunotherapy agents. AAG agents include inhibitors of vascular endothelial growth factor receptor signaling pathways and mammalian target of rapamycin inhibitors. Both of these classes of targeted agents are considered cytostatic rather than cytotoxic, inducing tumor stabilization rather than marked tumor shrinkage. As a result, decreases in tumor size alone are often minimal and/or occur late in the course of successful AAG therapy, while tumor devascularization is a distinct feature of AAG therapy. In successful AAG therapy, tumor devascularization manifests on computed tomography images as a composite of a decrease in tumor size, a decrease in tumor attenuation, and the development of tumor necrosis. In this article, we review Response Evaluation Criteria in Solid Tumors (RECIST)—the current standard of care for tumor treatment response assessment which is based merely on changes in tumor length—and its assessment of metastatic RCC tumor response in the era of AAG therapies. We then review the features of an ideal tumor imaging biomarker for predicting metastatic RCC response to a particular AAG agent and serving as a longitudinal tumor response assessment tool. Finally, a discussion of the more recently proposed imaging response criteria and new imaging trends in metastatic RCC response assessment will be reviewed.

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Authors and Affiliations

  1. Department of Radiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    Reza Sirous, Candace M. Howard, Frederico Souza & Andrew D. Smith

  2. Department of Hematology/Oncology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    John C. Henegan

  3. Center for Biostatistics and Bioinformatics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    Xu Zhang

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  1. Reza Sirous
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  2. John C. Henegan
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  3. Xu Zhang
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  5. Frederico Souza
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  6. Andrew D. Smith
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Correspondence to Andrew D. Smith.

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Conflicts of Interest

Andrew D. Smith has received an investigator-initiated grant from Pfizer. Andrew D. Smith is the president of Radiostics LLC, a core imaging lab focused on image interpretation for industry-sponsored clinical trials. Andrew D. Smith is the president of eMASS LLC and has a patent pending related to the vascular tumor burden technology described in this manuscript. Andrew D. Smith is the president of Liver Nodularity LLC and has a patent pending. Andrew D. Smith is the president of Color Enhanced Detection LLC and has a patent pending. All other authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived for the retrospective studies described in the manuscript.

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Sirous, R., Henegan, J.C., Zhang, X. et al. Metastatic renal cell carcinoma imaging evaluation in the era of anti-angiogenic therapies. Abdom Radiol 41, 1086–1099 (2016). https://doi.org/10.1007/s00261-016-0742-7

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