Early prediction of response to sorafenib in patients with advanced hepatocellular carcinoma: The role of dynamic contrast enhanced ultrasound
Adult
Male
Niacinamide
Carcinoma, Hepatocellular
Tumour response
Hepatocellular carcinoma
Endpoint Determination
Angiogenesis Inhibitors
Antineoplastic Agents
Disease-Free Survival
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Humans
Prospective Studies
Dynamic contrast enhanced ultrasound
Aged
Retrospective Studies
Phenylurea Compounds
Liver Neoplasms
Sorafenib
Middle Aged
3. Good health
Liver
Disease Progression
Feasibility Studies
Female
DOI:
10.1016/j.jhep.2013.06.011
Publication Date:
2013-06-25T12:24:41Z
AUTHORS (15)
ABSTRACT
Sorafenib has become the standard first-line treatment for patients with advanced HCC and acts by inducing alterations in tumor vascularity. We wanted to evaluate the feasibility of dynamic CEUS (D-CEUS) as a predictor of early tumor response to sorafenib and to correlate functional parameters with clinical efficacy end points.Twenty-eight HCC patients treated with sorafenib 400mg bid were prospectively enrolled. CEUS was performed at baseline (T0) and after 15 (T1) and 30 (T2) days of treatment. Tumor vasculature was assessed in a specific harmonic mode associated with a perfusion and quantification software (Q-Lab, Philips). Variations between T1/T2 and T0 were calculated for five D-CEUS functional parameters (peak intensity, PI; time to PI, TP; area under the curve, AUC; slope of wash in, Pw; mean transit time, MTT) and were compared for responders and non-responders. The correlation between D-CEUS parameters, overall survival (OS), and progression-free survival (PFS) was also assessed. A p value <0.05 was considered statistically significant.The percentage variation at T1 significantly correlated with response in three D-CEUS parameters (AUC, PI and Pw; p=0.002, <0.001, and 0.003, respectively). A decrease of AUC (p=0.045) and an increased/unchanged value of TP (p=0.029) and MTT (p=0.010) were associated with longer survival. Three D-CEUS parameters (AUC, TP, Pw) were significantly associated with PFS.D-CEUS provides a reliable and early measure of efficacy for anti-angiogenic therapies and could be an excellent tool for selecting patients who will benefit from treatment.
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