Dynamic contrast-enhanced CT in patients treated with sorafenib and erlotinib for non-small cell lung cancer: a new method of monitoring treatment?

Abstract

ObjectiveWe investigated the feasibility of serial dynamic contrast-enhanced computed tomography (DCE-CT) in patients with advanced/metastatic non-small cell lung cancer (NSCLC) receiving anti-angiogenic (sorafenib) and anti-EGFR (erlotinib) treatment, and correlated tumour blood flow (BF) with treatment outcome.MethodsDCE-CTs were performed at baseline and 3 and 6 weeks after starting treatment. Tumour BF, calculated with the maximum slope method, and percentage change were measured in 23 patients (14 male; median age 59 years). Tumour BF was compared at baseline and weeks 3 and 6; the relation with RECIST/Crabb response and progression-free survival (PFS) was assessed.ResultsMean tumour perfusion decreased from 39.2 ml/100 g/min at baseline to 15.1 ml/100 g/min at week 3 (p < 0.001) and 9.4 ml/100 g/min at week 6 (p < 0.001). Tumour perfusion was lower in RECIST and Crabb responders versus non-responders at week 3 (4.2 versus 17.7 ml/100 g/min, p = 0.03) and week 6 (0 versus 13.4 ml/100 g/min, p = 0.04). Patients with a decrease larger than the median at week 6 tended to have a longer PFS (7.1 versus 5.7 months, p = 0.06).ConclusionSerial DCE-CTs are feasible in patients with NSCLC and demonstrated a significant decrease in tumour BF following sorafenib/erlotinib therapy. Early changes in tumour BF correlated with objective response and showed a trend towards longer PFS.

Functional imaging of lung cancer using dual energy CT: how does iodine related attenuation correlate with standardized uptake value of 18FDG-PET-CT?

“…De Langen et al demonstrated that patients with lung cancer showed lower SUV max on 18 FDG PET-CT and decreasing tumour perfusion on DCE-MRI after anti-angiogenic therapy when compared to their baseline imaging [32]; similarly, Lind et al investigated the feasibility of DCE-CT in patients with advanced NSCLC who received anti-angiogenic and anti-EGFR treatment and found a significant decrease in tumour blood flow following targeted therapy. Moreover, early changes in tumour blood flow correlated with objective response and showed a trend towards longer progression free survival [33]. In another study involving 26 patients with stage III NSCLC, a significant decrease in the SUV max of the primary tumour was found a few weeks after the completion of preoperative chemoradiotherapy when compared with the baseline study.…”

Current status and guidelines for the assessment of tumour vascular support with dynamic contrast-enhanced computed tomography

“…1) [10]. These trials date back to 1994 and have not only included drugs that target the tumour vasculature but also drugs with other therapeutic mechanisms (Table 3) [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. In some cases, the results from DCE-CT have assisted the "go-no go" decision concerning further drug development, and/or helped to determine a dose to take forward to later development phases.…”

The value of perfusion CT in predicting the short-term response to synchronous radiochemotherapy for cervical squamous cancer

“…Although this technique confers a additional radiation dose to the patient, perfusion CT has many advantages such as being convenient and fast, and it has been used for the assessment of response to therapy of tumours in the head, liver, lung, pancreas, kidney, rectum, etc. [6][7][8][9][10][11].…”