Detection of Early Tumor Response to Axitinib in Advanced Hepatocellular Carcinoma by Dynamic Contrast Enhanced Ultrasound

Abstract

This study aimed to evaluate the utility of dynamic contrast-enhanced ultrasound (DCE-US) in measuring early tumor response of advanced hepatocellular carcinoma to axitinib. Twenty patients were enrolled (aged 18-78 y; median 65). DCE-US was performed with bolus injection and infusion/disruption replenishment. Median overall survival was 7.1 mo (1.8-27.3) and progression free survival was 3.6 mo (1.8-17.4). Fifteen patients completed infusion scans and 12 completed bolus scans at 2 wk. Among the perfusion parameters, fractional blood volume at infusion (INFBV) decreased at 2 wk in 10/15 (16%-81% of baseline, mean 47%) and increased in 5/15 (116%-535%, mean 220%). This was not significantly associated with progression free survival (p = 0.310) or progression at 16 wk (p = 0.849), but was borderline statistically significant (p = 0.050) with overall survival, limited by a small sample size. DCE-US is potentially useful in measuring early tumor response of advanced hepatocellular carcinoma to axitinib, but a larger trial is needed.

Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2020 – WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS

“…Since antiangiogenic treatments frequently induce necrosis without causing tumor shrinkage, functional imaging techniques are particularly suitable for the early assessment of response, a task for which both the RECIST and World Health Organization (WHO) size criteria [247,248] are unsatisfactory. Studies of various types of tumors such as HCC, gastrointestinal stromal tumor (GIST) or renal cell carcinoma (RCC) treated with antiangiogenic therapies have confirmed that DCEUS may allow early prediction of response to treatment [91,96,[249][250][251][252][253][254][255][256][257][258][259][260][261][262]. The first multicenter study including more than 500 patients in 19 centers [263] correlated DCEUS with progression free survival (PFS) and overall survival (OS).…”

Quantitative dynamic contrast-enhanced ultrasound may help predict the outcome of hepatocellular carcinoma after microwave ablation

“…a series of studies have reported that DCE-US parameters are predictive of tumor response, progression-free survival, and OS after different targeted therapies, including bevacizumab [11], sorafenib [33], and axitinib [34]. In addition to early prediction of tumor response, DCE-US parameters were shown to be strongly correlated with major adverse events of HCC patients after sorafenib treatment [35].…”

Prognostic value of enhancement rate by enhanced ultrasound in hepatitis B virus‐positive hepatocellular carcinoma undergoing radiofrequency ablation

“…Contrast enhanced ultrasound (CEUS) has been known as a common tool for evaluating of blood perfusion . Experimental and clinical studies have revealed that CEUS is useful to evaluate the blood perfusion characteristics of untreated HCC . Hence, in this study, we try to quantitatively assess the perfusion characteristics of HCC by CEUS, and analyze prognostic significance of such perfusion parameters for HCC patients undergoing RAF treatments.…”