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Lookup NU author(s): Professor James WasonORCiD, Helen MossopORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s) 2025.Abstract: Despite recent therapeutic advances, renal cell carcinoma (RCC) has a high mortality rate. The development of new neoadjuvant strategies requires reliable companion biomarkers of early and successful response to treatment. A change in tumor size is a late measure of response and novel targeted imaging-based biomarkers may be more accurate for treatment response prediction. Here we evaluated the potential of hyperpolarized carbon-13 MRI (HP 13C-MRI), following the injection of hyperpolarized 13C-pyruvate, to assess response to neoadjuvant treatment in four patients with clear cell RCC as an exploratory outcome within a prospective clinical trial. The change in the tumor lactate-to-pyruvate ratio (LAC/PYR) following treatment varied across the patients: mean percentage change ± S.D. = +6 ± 27%. The largest decrease in LAC/PYR ratio was in the patient treated with cediranib monotherapy (-21%), followed by a smaller reduction in a patient receiving the combination of cediranib and olaparib (-14%). An increase in the LAC/PYR ratio post-treatment was observed in the second patient receiving combination treatment (+ 21%), with the largest increase in the patient receiving olaparib monotherapy (+ 35%). Metabolic changes were observed following treatment in the absence of significant changes in tumor size. In summary, HP 13C-MRI successfully captured heterogeneous metabolic responses to cediranib and olaparib therapy, revealing both increases and decreases in tumor lactate labelling, independent of any morphologic change. Finally, this is the first study to evaluate the potential of clinical HP 13C-MRI to assess early treatment response in renal cancer by using a range of therapeutics. Key take home message: The study provides preliminary evidence supporting HP 13C-MRI as a promising imaging biomarker for evaluating early metabolic changes in renal cell carcinoma following neoadjuvant therapy. Clinical Trials Registry: NCT03741426, Registration date: 13 November 2018.
Author(s): Horvat-Menih I, McLean MA, Birchall J, Zamora Morales MJ, Wylot M, Ursprung S, Woitek R, Serrao E, Grimmer A, Latimer E, Khan AS, Priest AN, Gill AB, Kaggie JD, Graves MJ, Barrett T, Wason JMS, Mossop H, Thomas M, Said S, Warren AY, Fife K, Eisen T, Matakidou A, Ince W, O'Carrigan B, Jones JO, Welsh SJ, Mitchell TJ, Armitage JN, Riddick ACP, Stewart GD, Gallagher FA
Publication type: Article
Publication status: Published
Journal: Abdominal Radiology
Year: 2025
Pages: epub ahead of print
Online publication date: 10/12/2025
Acceptance date: 17/11/2025
Date deposited: 23/12/2025
ISSN (print): 2366-004X
ISSN (electronic): 2366-0058
Publisher: Springer
URL: https://doi.org/10.1007/s00261-025-05313-z
DOI: 10.1007/s00261-025-05313-z
Data Access Statement: Data availability: Data generated or analyzed during the study are available from the corresponding author upon request. Code availability: Custom computer code was used to generate the results for imaging and is available upon request
PubMed id: 41369900
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