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Clinical Trial
. 2010 Dec;20(12):2890-8.
doi: 10.1007/s00330-010-1869-5. Epub 2010 Jul 13.

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

Joline S W Lind  1 , Martijn R Meijerink, Anne-Marie C Dingemans, Cornelis van Kuijk, Michel C Ollers, Dirk de Ruysscher, Pieter E Postmus, Egbert F Smit
Affiliations
Clinical Trial

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

Joline S W Lind et al. Eur Radiol. 2010 Dec.

Abstract

Objective: We 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.

Methods: DCE-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.

Results: Mean 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).

Conclusion: Serial 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.

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Figures

Fig. 1
Fig. 1
An example of serial DCE-CT and perfusion parameter maps of the thorax (axial plane) of a study patient. a Tumour blood flow at baseline was 95.2 ml/100 g/min. b After 3 weeks of treatment tumour cavitation was present and the blood flow had decreased to 18.2 ml/100 g/min. c After 6 weeks there was more extensive tumour cavitation. Blood flow in the remaining peripheral tumour tissue had decreased to 7.0 ml/100 g/min
Fig. 2
Fig. 2
Box plots showing a tumour blood flow at baseline and 3 and 6 weeks after starting treatment and b percentage tumour change after 3 and 6 weeks of treatment. Tumour blood flow decreased significantly after 3 and 6 weeks (p < 0.001)
Fig. 3
Fig. 3
Box plots showing tumour blood flow according to a RECIST tumour response and b tumour response according to Crabb. Responders (unshaded blocks) had significantly lower blood flow after 3 and 6 weeks of treatment compared with non-responders (shaded blocks) according to both response methods
Fig. 4
Fig. 4
Bar chart showing percentage change in tumour blood flow according to a RECIST tumour response and b tumour response according to Crabb. Responders (unshaded blocks) had a significantly larger decrease in blood flow after 3 and 6 weeks of treatment compared with non-responders (shaded blocks) according to both response methods
Fig. 5
Fig. 5
Kaplan–Meier curve of progression-free survival (PFS). Patients with a decrease in tumour blood flow larger than the median decrease at week 6 (solid line) tended to have a longer PFS versus patients with a change in blood flow smaller than the median decrease at week 6 (dashed line) (p = 0.06)
See this image and copyright information in PMC

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