Imaging and clinical correlates with regorafenib in metastatic colorectal cancer. (June 2020)

• Record Type: Journal Article
• Authors: Khan, Khurum; Cascinu, Stefano; Cunningham, David; Kim, Sun-Young; Oki, Eiji; Seery, Tara; Shen, Lin; Siena, Salvatore; Tournigand, Christophe; Turhal, Nazim Serdar; Hendlisz, Alain
• Is Part Of: Cancer treatment reviews. Volume 86(2020)
• Publication Date: 2020-06
• Subjects: Regorafenib -- Computed tomography -- Metastatic colorectal cancer -- Magnetic resonance imaging -- Positron emission tomography; Cancer -- Periodicals; Cancer -- Treatment -- Periodicals; Neoplasms -- therapy -- Periodicals; Cancer -- Périodiques; Cancer -- Traitement -- Périodiques; Cancer -- Treatment; Electronic journals; Periodicals; 616.99406
• DOI: 10.1016/j.ctrv.2020.102020
• Languages: English
• ISSNs: 0305-7372

Abstract

Highlights: Regorafenib is a tyrosine kinase inhibitor used to treat metastatic CRC. Timely detection of non-responders to regorafenib may limit unnecessary exposure. Regorafenib-induced changes in tumor density or vasculature correlate with outcomes. Imaging data show radiologic markers of response after 2–4 weeks of regorafenib. Differences between CT, MRI, and PET to identify regorafenib response are discussed. Abstract: In colorectal cancer (CRC), imaging is important in determining tumor stage, selecting treatment strategies, and in assessing response to therapy. However, some challenges remain with established imaging techniques, such as computed tomography, and with some commonly used response criteria, such as Response Evaluation Criteria in Solid Tumors, which measures change in size of several target lesions instead of change in tumor morphology or metabolic function. In addition, these assessments are not typically conducted until after 8 weeks of treatment, meaning that potential non-responders are often not identified in a timely manner. Regorafenib, an oral tyrosine kinase inhibitor indicated for the treatment of metastatic CRC, blocks the activity of several protein kinases involved in angiogenesis, oncogenesis, metastasis, and tumor immunity. Timely differentiation of regorafenib responders from non-responders using appropriate imaging techniques that recognize not only changes in tumor size but also changes in tumor density or vasculature, may reduce unnecessary drug-related toxicity in patients who are unlikely to respond to treatment. This review discusses the latest developments in computed tomography, magnetic resonance imaging, and positron emission tomography tumor imaging modalities, and how these aid in identifying patients with metastatic CRC who are responders or non-responders to regorafenib treatment.