CT density heterogeneity in renal cancer

• Research type

  Research Study

• Full title

  CT density heterogeneity as a marker of response to targeted agents in metastatic renal cancer

• IRAS ID

  265268

• Contact name

  Natalie Charnley

• Contact email

  natalie.charnley@lthtr.nhs.uk

• Sponsor organisation

  Lancashire Teaching Hospitals NHS Foundation Trust

• Duration of Study in the UK

  1 years, 0 months, 1 days

• Research summary

  Treatment in metastatic renal cancer has focussed on tyrosine kinase inhibitors which target tumour blood vessels (anti VEGF dugs). Recently, a combination of immunotherapy agents (anti PDL1 and anti CTLA4 inhibitors) has shown to be superior and is now gold standard for fit patients. A combination of immunotherapy with anti VEGF dugs gives better response than anti VEGF drugs and will be available next year.
  At present we have no clear histological markers to guide which patients should have certain treatments.
  Radiological predictors of response have the benefit of representation of all tumours.
  Recently there has been interest in the heterogeneity of density on CT to predict outcome and response in renal cancer. One study has shown that heterogeneity is related to outcome in patients who receive a tyrosine kinase inhibitor in renal cancer.(1) There is early work, in lung cancer, that density subtypes can be related to histology (2), and outcome.
  We propose to explore density heterogeneity on CT in relation to response to treatments in patients with metastatic renal cancer.
  We hypothesise that there will be a certain density clustering in patients that respond well to immunotherapy , and a different clustering in those who respond poorly. We also propose there will be unique clustering in those that respond well to tyrosine kinase inhibitors to vegf and again different clustering in those that respond poorly. This could direct patients to the treatment they will do best, possibly avoid more intensive treatment for some patients, and possibly reduce costs for these patients

  We will examine tumour density heterogeneity in CT scans from Lancs teaching hospitals of patients who have already had or are having treatment for metastatic renal cancer, and will try to identify density clusters in patients who have responded really well or poorly to treatment.
  

• REC name

  London - Chelsea Research Ethics Committee

• REC reference

  19/LO/1159

• Date of REC Opinion

  4 Jul 2019

• REC opinion

  Further Information Favourable Opinion