New trend in oncology

Antiangiogenetic factors as a systemic approach to hypervascular neoplasm are actually the only effective chance for the treatment of patietents affected by advanced stage of Renal cell carcinoma. Sorafenib (BAY 43-9006,
Nexavar®) is a multi-kinase inhibitor which targets receptor tyrosine and serine/threonine kinases involved in tumor progression and tumor angiogenesis.
Phase III trials reveal a strong activity of these pharms in reducing the vascularization
and in the tabilization of the disease. Unfortunely the use of single agent, acting in single biochemcal pathway, is correlated with short time of tumor growth control (about 4 mounth). After this period the tumor and its secondary tend to progress in size and in the degree of vascularization. New systemic antiangiogenetic applications are the performace of multiantiangiogenetic protocols, acting in differnt bichemical pathways, in order to improve the prognosis and the median survival time. No scientific datas are actually available about long term prognosis after antiagiogenetic drugs.
Radiology, in particular CT, is crucial in the assesmet of these patients
Main findings are:
reduction of contrast enanchement in the arterial phase (devascularization)
Targeted appearance of the mass due to central necrosis; in some cases necrosis is responsible for the paradoxal growth in dimension of devascularized tumor (new criteria , EASL, for the tumor follow-up are now available).
The tumor progression is characterized by the reappearance of hypervascular componet especially in necrotic areas with its progressive reduction in size