877 - A Review of Radiological Assessment Response in Metastatic Renal Cell Carcinoma Treated with Antiangiogenic Therapy- are we Hitting the Target?

Abstract

ABSTRACT Background Targeted therapy has changed the treatment landsacpe of metastatic renal cell carcinoma (RCC) in the last years. However, despite the positive results with antiangiogenic drugs in the treatment of metastatic RCC, the evaluation of response to these therapies remains undefined. This study aimed to review different proposed radiologic methods used for response evaluation with antiangiogenic agents in RCC. Methods A no systematic literature review using electronic databases PubMed/MEDLINE, EMBASE, Cochrane Library and LILACS with the terms “renal cell carcinoma”, “response criteria” and “targeted therapy” and its variables. Results A total of 53 articles were identified, of which 12 were selected and 41 excluded. After evaluation of the references of the 12 selected studies, two new studies were included. The 14 studies were published from August 2009 to October 2011, 11 of them using computed tomography as a method of response evaluation, one with doppler ultrasound and two others with positron emission tomography. A total of 927 patients were studied. The drugs used for analysis in the different studies were sunitinib, sorafenib, cediranibe, bevacizumab and interferon alpha; but sunitinib and sorafenib are variously present in all studies. The retrospective design was the basis for most of the analysis (71%) and endpoints analysed for method comparison were time to disease progression (TTP) or progression-free survival (PFS). All studies had RECIST as the assessment parameters (control). Proposed new methods of radiographic response criteria in this context were present in 11 studies (78%). In 3 studies (21%) only one radiologist reviewed the images, in the other at least 2 radiologists participated in the evaluation. Most studies evaluated a small number of patients and 8 studies (57%) included more than one antiangiogenic drugs in its analysis. Conclusion Antiangiogenic drugs are considered standard therapy in the treatment of metastatic RCC. Phase III trials are needed to validate the best radiological response criteria in this context, new proposed methods should be incorporated as secondary end-points in future prospective trials. Disclosure All authors have declared no conflicts of interest.