Beyond the Vascular Endothelial Growth Factor Axis: Update on Role of Imaging in Nonantiangiogenic Molecular Targeted Therapies in Oncology

Abstract

A substantial number of molecular targeted therapies act on nonantiangiogenic pathways. Familiarity with these drugs, their personalized tumor response criteria, and class- and drug-specific toxicities will help radiologists to be an integral part of the multi-disciplinary oncology team.

Molecular Targeted Therapy in Modern Oncology: Imaging Assessment of Treatment Response and Toxicities

“…Radiologists should also be aware of other potential imaging manifestions of EGFR TKI toxicity, including diarrhea/colitis, pneumatosis and periportal edema related to hepatic failure (63). Diarrhea/colitis is commonly reported, evidenced by fluid filled colon, dilation, wall thickening and/or mesenteric hyperemia (63).…”

“…Diarrhea/colitis is commonly reported, evidenced by fluid filled colon, dilation, wall thickening and/or mesenteric hyperemia (63). In contrast, pneumatosis and periportal edema related to hepatic failure are rare events (63).…”

“…Diarrhea/colitis is commonly reported, evidenced by fluid filled colon, dilation, wall thickening and/or mesenteric hyperemia (63). In contrast, pneumatosis and periportal edema related to hepatic failure are rare events (63). It is worthwhile to mention that each of the EGFR TKIs toxicities can be seen in patients treated with these agents in other cancer settings (e.g., erlotinib treatment of pancreatic cancer; cetuximab (Erbitux; Bristol-Myers Squibb, New York, NY, USA) treatment of advanced squamous cell carcinoma of the head and neck) (6465).…”

Evolving Cancer Classification in the Era of Personalized Medicine: A Primer for Radiologists

“…CT findings of pneumonitis include multifocal ground-glass opacities (Fig. 5) with or without interlobular septal thickening or diffuse ground glass changes with consolidation and traction bronchiectasis (2425). Colitis may be manifest on imaging as fluid-filled colon, mural thickening, pericolonic fat stranding, and hyperemic mesenteric vessels.…”

“…The acneiform skin rash seen with cetuximab as with SCCHN also in colon cancer correlates with a greater response rate in treatment (47). Imaging findings in panitumab toxicities include colitis which may appear as fluid filled colon, mural thickening, pericolonic fat stranding and hyperemia of mesenteric vessels and deranged liver function tests may be associated with periportal edema, gallbladder wall thickening and ascites (25). …”