Dynamic contrast-enhanced computed tomography as a potential biomarker in patients with metastatic colorectal cancer treated with regorafenib

Iben R Andersen*, Rene Olesen, Anders K Boysen, Lars H Jensen, Frank V Mortensen, Dennis T Nielsen, Finn Rasmussen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Background: RECIST 1.1 presents challenges when evaluating treatment response to angiogenesis inhibitors. The objective response rate, when evaluating the treatment effect of regorafenib, using RECIST 1.1, is < 2% and beneficial treatment could erroneously be terminated. Dynamic contrast-enhanced computed tomography (DCE-CT) has potential as a non-invasive functional imaging biomarker, by quantifying the treatment effect of this targeted therapy. Purpose: To evaluate three-dimensional (3D) tumor dynamic parameters representing tumor microcirculation assessed by DCE-CT during the treatment with regorafenib in a cohort of patients with treatment-refractory metastatic colorectal cancer. Material and Methods: Thirty-three patients with colorectal metastases (27 liver lesions, three abdominal lesions, and three pulmonary lesions) were treated with regorafenib and evaluated using DCE-CT. A total of 112 DCE-CT scans were analyzed using Advanced Perfusion and Permeability Application and correlated to standard contrast-enhanced computed tomography (CE-CT) evaluated using RECIST 1.1. Results: A significant decrease in most DCE-CT parameters, a simultaneous decrease in tumor attenuation and an increase in tumor volume were detected during treatment. However, no associations were found between the DCE-CT parameters and PFS or OS using simple COX proportional hazards regression. Conclusion: In this exploratory study, a significant decrease in most dynamic parameters suggests an overall treatment effect of regorafenib in tumor vasculature. DCE-CT may assist in an objective evaluation of these responses compared to RECIST. The anti-angiogenic changes could not be associated with treatment outcome in terms of PFS and OS, which might be due to the small cohort or a rather limited survival benefit in this pre-medicated treatment-refractory group of patients.

Original languageEnglish
JournalActa Radiologica
Issue number7
Pages (from-to)836-845
Publication statusPublished - 1. Jul 2019


  • CT quantitative
  • angiogenesis inhibitors
  • dynamic contrast-enhanced computed tomography
  • metastatic colorectal cancer
  • patient outcome
  • Liver Neoplasms/diagnostic imaging
  • Colorectal Neoplasms/pathology
  • Humans
  • Middle Aged
  • Four-Dimensional Computed Tomography/methods
  • Male
  • Response Evaluation Criteria in Solid Tumors
  • Treatment Outcome
  • Phenylurea Compounds/therapeutic use
  • Lung Neoplasms/diagnostic imaging
  • Contrast Media
  • Pyridines/therapeutic use
  • Radiographic Image Enhancement/methods
  • Abdominal Neoplasms/diagnostic imaging
  • Biomarkers
  • Triiodobenzoic Acids
  • Female
  • Aged

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