PREMETHEP
Hepatocellular carcinoma (HCC) is the third cause of death by cancer. For patients with
inoperable advanced HCC, systematic therapy with Sorafenib, a multikinase inhibitor that has
both antiangiogenic and antiproliferative effect, is the only therapeutic with proven
survival benefits. However, the efficacy of Sorafenib remains inconstant with a media overall
survival of 10,7 months and a disease control rate only 35 to 43%; moreover, the overall
incidence of treatment-related adverse event is 80%. Thus, it appears essential to find an
early and accurate way to determine which patients are best responding to therapy in order to
avoid the toxicity and cost of ineffective therapy. Positron Emission Tomography (PET) with 18F-Fluorodeoxyglucose (FDG) has shown limited
performance in the setting of HCC because of lack of sensitivity, in particular for
well-differentiated tumours. However FDG uptake is related to proliferation rate and is an
efficient marker survival following liver transplantation and selective internal radiation
therapy. Moreover, the addition of a dynamic first-pass acquisition to the standard static
scan provides better characterization of the tumour by adding information on tumour
perfusion. FCH which reflects lipids metabolism and specifically choline kinase activity, has shown
promising results for detection of HCC when compared with FDG alone. Moreover, choline
activity is related to a kinase pathway in mammalian cells, which is specifically inhibited
by Sorafenib. However FCH uptake remains inconstant in HCC, and is related to tumour
differentiation, by opposition to FDG. Therefore, several studies have suggested that
combined evaluation of tumour glucose and lipid metabolism could play a complementary role
for the evaluation of HCC in the setting of detection, staging and to predict recurrence
following surgical resection. Thus, the investigator hypothesize that the combination of FDG
and FCH may be the most accurate imaging evaluation of HCC. Thus the aim of the present study is to determine the predictive performance of survival of
lipid and glucose metabolism and perfusion changes during Sorafenib therapy in patients with
advanced HCC.
Mar 27,2017
All
18 Years
99 Years
18 Years
99 Years
87