Related Experiment Video
Updated: Oct 15, 2025
Dynamic Contrast Enhanced Magnetic Resonance Imaging of an Orthotopic Pancreatic Cancer Mouse Model
Published on: April 18, 2015
Multiparametric MRI for assessment of early response to neoadjuvant sunitinib in renal cell carcinoma
Stephan Ursprung1,2, Andrew N Priest1,3, Fulvio Zaccagna1
1University of Cambridge, Cambridge, United Kingdom.
Purpose:
To detect early response to sunitinib treatment in metastatic clear cell renal cancer (mRCC) using multiparametric MRI.
Method:
Participants with mRCC undergoing pre-surgical sunitinib therapy in the prospective NeoSun clinical trial (EudraCtNo: 2005-004502-82) were imaged before starting treatment, and after 12 days of sunitinib therapy using morphological MRI sequences, advanced diffusion-weighted imaging, measurements of R2* (related to hypoxia) and dynamic contrast-enhanced imaging. Following nephrectomy, participants continued treatment and were followed-up with contrast-enhanced CT. Changes in imaging parameters before and after sunitinib were assessed with the non-parametric Wilcoxon signed-rank test and the log-rank test was used to assess effects on survival.
Results:
12 participants fulfilled the inclusion criteria. After 12 days, the solid and necrotic tumor volumes decreased by 28% and 17%, respectively (p = 0.04). However, tumor-volume reduction did not correlate with progression-free or overall survival (PFS/OS). Sunitinib therapy resulted in a reduction in median solid tumor diffusivity D from 1298x10-6 to 1200x10-6mm2/s (p = 0.03); a larger decrease was associated with a better RECIST response (p = 0.02) and longer PFS (p = 0.03) on the log-rank test. An increase in R2* from 19 to 28s-1 (p = 0.001) was observed, paralleled by a decrease in Ktrans from 0.415 to 0.305min-1 (p = 0.01) and a decrease in perfusion fraction from 0.34 to 0.19 (p<0.001).
Conclusions:
Physiological imaging confirmed efficacy of the anti-angiogenic agent 12 days after initiating therapy and demonstrated response to treatment. The change in diffusivity shortly after starting pre-surgical sunitinib correlated to PFS in mRCC undergoing nephrectomy, however, no parameter predicted OS.
Trial Registration:
EudraCtNo: 2005-004502-82.
Insights
Multiparametric MRI detected early response to sunitinib in metastatic renal cell carcinoma (mRCC) within 12 days. Changes in tumor diffusivity correlated with progression-free survival, confirming treatment efficacy.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Metastatic clear cell renal cancer (mRCC) requires effective early treatment response detection.
- Sunitinib is an anti-angiogenic agent used in mRCC treatment.
- Assessing treatment efficacy early can guide patient management and improve outcomes.
Purpose of the Study:
- To evaluate multiparametric MRI for early detection of treatment response to sunitinib in mRCC.
- To correlate imaging parameters with clinical outcomes such as progression-free survival (PFS) and overall survival (OS).
Main Methods:
- Prospective study of 12 mRCC patients receiving pre-surgical sunitinib therapy.
- Multiparametric MRI (morphological, diffusion-weighted, R2*, DCE-MRI) performed before and after 12 days of treatment.
- Correlation of imaging changes with RECIST response, PFS, and OS using statistical tests.
Main Results:
- Tumor volumes (solid and necrotic) decreased significantly after 12 days of sunitinib (p=0.04).
- Reduced tumor diffusivity (D) correlated with better RECIST response (p=0.02) and longer PFS (p=0.03).
- Increased R2* and decreased Ktrans and perfusion fraction indicated treatment effects.
Conclusions:
- Multiparametric MRI effectively demonstrates early anti-angiogenic effects of sunitinib in mRCC after 12 days.
- Changes in tumor diffusivity early in treatment are a potential biomarker for predicting PFS.
- No imaging parameter reliably predicted overall survival in this cohort.
