Assessment of response to anti-angiogenic targeted therapy in pulmonary metastatic renal cell carcinoma: R2* value as a predictive biomarker

Purpose To evaluate the utility of MR R2*-mapping and the optimal time-point for assessing the response of pulmonary metastatic renal cell carcinoma (mRCC) to anti-angiogenic targeted therapy (aATT). Materials and methods The exploration-sample group and the validation-sample group consisted of 22 and 16 patients. The parameters of MR R2*-mapping, including the R2* value at each time-point (R2* base , R2* 1cyc and R2* 2cyc ) and change between different time-points (R2* (1cyc-base)/base , R2* (2cyc-base)/base and R2* (2cyc-1cyc)/1cyc ), were evaluated with a receiver-operating-characteristic analysis, and a cut-off value derived from the clinical outcome was applied to the Kaplan-Meier method to assess the value of R2* mapping and Response-Evaluation-Criteria in Solid Tumours (RECIST) during treatment evaluation. Results The inter-, intra-observer agreements and inter-scan consistency were excellent (p > 0.80). For the exploration-sample group, the areas under the curve for the parameters of MR R2* mapping were 0.55, 0.60, 0.83, 0.64, 0.88 and 0.83 for R2* base , R2* 1cyc , R2* 2cyc , R2* (1cyc-base)/base , R2* (2cyc-base)/base and R2* (2cyc-1cyc)/1cyc. For the validation-sample, R2* (2cyc-base)/base better predicted progression-free survival (p = 0.03) than RECIST and other R2* mapping parameters with a lower p value. Conclusion Assessing aATT outcome based on changes in the R2* value between baseline and second treatment is more accurate than assessment at other time-points and assessment based on the RECIST. Key Points • The inter-scan consistency of R2*-mapping in pulmonary mRCC are excellent . • The intra-/inter-observer agreement of R2* mapping in pulmonary mRCC are excellent . • Using changes in R2* value between baseline/after second-treatment is better than RECIST . • The choice of baseline/after second treatment is better than other time-points .