Feasibility Study on Using Dynamic Contrast Enhanced MRI to Assess the Effect of Tyrosine Kinase Inhibitor Therapy within the STAR Trial of Metastatic Renal Cell Cancer

• Main Authors: Jim Zhong, Ebrahim Palkhi, David L. Buckley, Fiona J. Collinson, Christy Ralph, Satinder Jagdev, Naveen S. Vasudev, Jayne Swain, Janet E. Brown, Tze Min Wah
• Format: Article
• Language: English
• Published: MDPI AG 2021-07-01
• Series: Diagnostics
• Subjects: dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI); tyrosine kinase inhibitor; anti-angiogenic therapy; metastatic renal cell cancer
• Online Access: https://www.mdpi.com/2075-4418/11/7/1302

<i>Objective</i>: To identify dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters predictive of early disease progression in patients with metastatic renal cell cancer (mRCC) treated with anti-angiogenic tyrosine kinase inhibitors (TKI). <i>Methods</i>: The study was linked to a phase II/III randomised control trial. Patients underwent DCE-MRI before, at 4- and 10-weeks after initiation of TKI. DCE-MRI parameters at each time-point were derived from a single-compartment tracer kinetic model, following semi-automated tumour segmentation by two independent readers. Primary endpoint was correlation of DCE-MRI parameters with disease progression at 6-months. Receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) values were calculated for parameters associated with disease progression at 6 months. Inter-observer agreement was assessed using the intraclass correlation coefficient (ICC). <i>Results</i>: 23 tumours in 14 patients were measurable. Three patients had disease progression at 6 months. The percentage (%) change in perfused tumour volume between baseline and 4-week DCE-MRI (<i>p</i> = 0.016), mean transfer constant K^trans change (<i>p</i> = 0.038), and % change in extracellular volume (<i>p</i> = 0.009) between 4- and 10-week MRI, correlated with early disease progression (AUC 0.879 for each parameter). Inter-observer agreement was excellent for perfused tumour volume, K^trans and extracellular volume (ICC: 0.928, 0.949, 0.910 respectively). <i>Conclusions</i>: Early measurement of DCE-MRI biomarkers of tumour perfusion at 4- and 10-weeks predicts disease progression at 6-months following TKI therapy in mRCC.