Advanced Ultrasound in Diagnosis and Therapy ›› 2026, Vol. 10 ›› Issue (3): 169-177.doi: 10.26599/AUDT.2026.250086
• ORIGINAL RESEARCH • Previous Articles Next Articles
Oronsky Bryana, Li Dandanb, Wang Morganb, Vo-Phamhi Jenny M.c,d, Caroen Scotta, Abrouk Nacera, Reid Tonya, Alizadeh Babaka, Hristov Dimitree, Fisher Georgef, Kaffas Ahmed Elg,*(
)
Received:2025-08-09
Revised:2025-08-20
Accepted:2025-12-08
Online:2026-09-30
Published:2026-10-12
Contact:
Kaffas Ahmed El,
E-mail:aelkaffas@health.ucsd.edu
Oronsky Bryan, Li Dandan, Wang Morgan, Vo-Phamhi Jenny M., Caroen Scott, Abrouk Nacer, Reid Tony, Alizadeh Babak, Hristov Dimitre, Fisher George, Kaffas Ahmed El. 3D Dynamic Contrast-Enhanced Ultrasound for Personalized RRx-001 Dosing: A Preclinical and Clinical Pilot Study. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(3): 169-177.
Table 1
Patient Characteristics: stable disease (SD) and progressive disease (PD)"
| Patient number | Age (years) | Gender | Hb at baseline (g/dL) | ALT at baseline (U/L) | Albumin (g/dL) at baseline | Size of liver metastasis at baseline (mm) | Dose of RRx-001 (mg) | RECIST 1.1 relative change from day 0-56 |
| 1 | 75 | M | 9.2 | 60 | 3.3 | 67 | 66 | 0% SD |
| 2 | 64 | M | 8.7 | 70 | 3.1 | 82 | 66 | +26% PD |
| 3 | 58 | F | 9.6 | 45 | 4.1 | 29 | 66 | +15% SD |
Table 2
Mean 3D-DCE-US patient measurements of regional blood volume (RBV) and regional blood flow (RBF)"
| Patient | Parameter (× 104) | S00 | S01 | S02 | S03 |
| Confidence interval (CI) presented in parentheses. NA indicates no scan was performed, and no measurements are available. | |||||
| 1 | RBV | 3.87 (3.75, 4.00) | 18.9 (17.9, 19.9) | 8.64 (8.31, 8.97) | NA |
| RBF | 0.267 (0.228, 0.308) | 1.13 (0.868, 1.21) | 0.700 (0.544, 0.867) | NA | |
| 2 | RBV | 6.99 (6.55, 7.43) | 8.25 (7.78, 8.71) | 7.86 (7.15, 8.56) | 3.16 (2.98, 3.35) |
| RBF | 0.499 (0.331, 0.685) | 1.21 (0.617, 1.87) | 0.718 (0.445, 1.03) | 0.787 (0.596, 0.997) | |
| 3 | RBV | 5.96 (5.60, 6.31) | 6.32 (6.12, 6.52) | 2.94 (2.72, 3.16) | 0.923 (0.797, 1.05) |
| RBF | 2.50 (1.79, 3.28) | 1.17 (0.956, 1.40) | 0.111 (0.0831, 0.142) | 0.158 (0.0635, 0.276) | |
Figure 1
(A) 3D DCE-US detects dose-dependent changes in tumor perfusion parameters following RRx-001 treatment in mice. All animals available for control (n = 16) vs. 6 mg/kg (n = 13) vs. 12 mg/kg (n = 9) for each of 4 bolus-perfusion parameters shown as percent difference relative to baseline at 4 hrs and 24 hrs. Trend is noted in overall increases in perfusion parameters in mice receiving RRx-001. Peak enhancement (PE) reflects a measure of blood volume at the highest peak while area under the curve (AUC) represents total blood volume flowing in tumor from wash in to wash out. While a trend is noted for PE and AUC within 4 hours after treatment, AUC at 24 hours after treatment was the only one significant parameter (P = 0.02; compared to control at 24 hours after baseline). Time-to-peak (TP) is proportional to blood flow at wash-in and mean transit time (MTT) represents the total time it takes contrast to wash in and wash out (also a measure of blood flow). While increases in blood flow (i.e., faster wash-in and longer wash-out) are noted after RRx-001, these were not significant. Error bars are standard errors of the mean (SEM). Significance is represented as *P = 0.02 (Mann-Whitney test); (B) Contrast ultrasound image at peak enhancement of ~25 mm lesion on hind leg of animal viewed in sagittal, coronal, and axial planes. The yellow volume of interest designates the lesion in 3D."
Figure 2
Longitudinal 3D DCE-US reveals heterogeneous patient-specific perfusion responses to RRx-001 over two weeks. Panel A shows representative snapshot images from scan 00 (baseline), scan 01 (2-4 hours), scan 02 (7 days) and scan 03 (2 weeks) from the 3D-DCEUS of patient 2, and Panel B shows the same of patient 3, and Panel C is the perfusion TIC for patients 1, 2 and 3. The blue curve represents baseline scans before any RRx-001 treatment administration, the red curve represents 2-4 hours post first treatment, the green curve is 7 days post treatment and the purple curve 2 weeks after initial treatment. Note from C the drastic differences in baseline perfusion, and the change in perfusion for each patient. The same Philips EPIQ7 system and X6-1 transducer were used with the same imaging parameters as in mice, with the exception of custom adjustments to the focus and depth of imaging."
| [1] |
Chen Z, Han F, Du Y, Shi H, Zhou W. Hypoxic microenvironment in cancer: molecular mechanisms and therapeutic interventions. Signal Transduct Target Ther 2023; 8: 70.
doi: 10.1038/s41392-023-01332-8 |
| [2] |
Al-Husein B, Abdalla M, Trepte M, Deremer DL, Somanath PR. Antiangiogenic therapy for cancer: an update. Pharmacotherapy 2012; 32: 1095-1111.
doi: 10.1002/phar.1147 |
| [3] |
Van Cutsem E, Tabernero J, Lakomy R, Prenen H, Prausová J, Macarulla T, et al. Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J Clin Oncol 2012; 30: 3499-3506.
doi: 10.1200/JCO.2012.42.8201 |
| [4] |
Ganss R. Tumour vessel remodelling: new opportunities in cancer treatment. Vasc Biol 2020; 2: R35-R43.
doi: 10.1530/vb-19-0032 |
| [5] |
Kanter J, Oronsky B, Reid T, Caroen S, Stirn M, Brinkhaus F, et al. Explosive hazards identified during the manufacture and transportation of 1-Bromoacetyl-3,-dinitroazetidine (RRx-001). Org Process Res Dev 2022; 26: 3010-3014.
doi: 10.1021/acs.oprd.2c00109 |
| [6] |
Oronsky B, Scicinski J, Cabrales P, Minchinton A. RRx-001, an epigenetic-based radio- and chemosensitizer, has vascular normalizing effects on SCCVII and U87 tumors. Clin Epigenetics 2016; 8: 53.
doi: 10.1186/s13148-016-0220-7 |
| [7] |
Oronsky B, Reid T, Cabrales P. Vascular priming with RRx-001 to increase the uptake and accumulation of temozolomide and irinotecan in orthotopically implanted gliomas. J Drug Target 2021; 29: 998-1003.
doi: 10.1080/1061186X.2021.1904248 |
| [8] |
Oronsky B, Guo X, Wang X, Cabrales P, Sher D, Cannizzo L, et al. Discovery of RRx-001, a Myc and CD47 downregulating small molecule with tumor targeted cytotoxicity and healthy tissue cytoprotective properties in clinical development. J Med Chem 2021; 64: 7261-7271.
doi: 10.1021/acs.jmedchem.1c00599 |
| [9] |
Oronsky B. Profile EpicentRx, Inc. Hum Vaccin Immunother 2023; 19: 2184963.
doi: 10.1080/21645515.2023.2184963 |
| [10] |
Oronsky B, Carter C, Reid T, Brinkhaus F, Knox SJ. Just eat it: a review of CD47 and SIRP-alpha antagonism. Semin Oncol 2020; 47: 117-124.
doi: 10.1053/j.seminoncol.2020.05.009 |
| [11] |
Oronsky B, Reid TR, Larson C, Caroen S, Quinn M, Burbano E, et al. REPLATINUM phase III randomized study: RRx-001 + platinum doublet versus platinum doublet in third-line small cell lung cancer. Future Oncol 2019; 15: 3427-3433.
doi: 10.2217/fon-2019-0317 |
| [12] |
Oronsky B, Goyal S, Kim MM, Cabrales P, Lybeck M, Caroen S, et al. A review of clinical radioprotection and chemoprotection for oral mucositis. Transl Oncol 2018; 11: 771-778.
doi: 10.1016/j.tranon.2018.03.014 |
| [13] |
Bonomi M, Blakaj DM, Kabarriti R, Colvett K, Takiar V, Biagioli M, et al. PREVLAR: phase 2a randomized trial to assess the safety and efficacy of RRx-001 in the attenuation of oral mucositis in patients receiving head and neck chemoradiotherapy. Int J Radiat Oncol Biol Phys 2023; 116: 551-559.
doi: 10.1016/j.ijrobp.2022.12.031 |
| [14] |
Amioka A, Masumoto N, Gouda N, Kajitani K, Shigematsu H, Emi A, et al. Ability of contrast-enhanced ultrasonography to determine clinical responses of breast cancer to neoadjuvant chemotherapy. Jpn J Clin Oncol 2016; 46: 303-309.
doi: 10.1093/jjco/hyv215 |
| [15] |
El Kaffas A, Hoogi A, Zhou J, Durot I, Wang H, Rosenberg J, et al. Spatial characterization of tumor perfusion properties from 3D DCE-US perfusion maps are early predictors of cancer treatment response. Sci Rep 2020; 10: 6996.
doi: 10.1038/s41598-020-63810-1 |
| [16] |
Scicinski J, Oronsky B, Taylor M, Luo G, Musick T, Marini J, et al. Preclinical evaluation of the metabolism and disposition of RRx-001, a novel investigative anticancer agent. Drug Metab Dispos 2012; 40: 1810-1816.
doi: 10.1124/dmd.112.046755 |
| [17] |
El Kaffas A, Sigrist RMS, Fisher G, Bachawal S, Liau J, Wang H, et al. Quantitative three-dimensional dynamic contrast-enhanced ultrasound imaging: first-in-human pilot study in patients with liver metastases. Theranostics 2017; 7: 3745-3758.
doi: 10.7150/thno.20329 |
| [18] |
Zhou J, Zhang H, Wang H, Lutz AM, El Kaffas A, Tian L, et al. Early prediction of tumor response to bevacizumab treatment in murine colon cancer models using three-dimensional dynamic contrast-enhanced ultrasound imaging. Angiogenesis 2017; 20: 547-555.
doi: 10.1007/s10456-017-9566-5 |
| [19] |
Wang H, Hristov D, Qin J, Tian L, Willmann JK. Three-dimensional dynamic contrast-enhanced US Imaging for early antiangiogenic treatment assessment in a mouse colon cancer model. Radiology 2015; 277: 424-434.
doi: 10.1148/radiol.2015142824 |
| [20] |
Wei, K. Assessment of myocardial viability using myocardial contrast echocardiography. Echocardiography 2005; 22: 85-94.
doi: 10.1111/j.0742-2822.2005.04034.x |
| [21] |
Oronsky B, Fanger GR, Oronsky N, Knox S, Scicinski J. The implications of hyponitroxia in cancer. Transl Oncol 2014; 7: 167-173.
doi: 10.1016/j.tranon.2014.02.001 |
| [22] | Oronsky BT, Oronsky AL, Lybeck M, Oronsky NC, Scicinski JJ, Carter C, et al. Episensitization: defying time's arrow. Front Oncol 2015; 5: 134. |
| [23] |
Jani VP, Asaro R, Oronsky B, Cabrales P. RRx-001 increases erythrocyte preferential adhesion to the tumor vasculature. Int J Mol Sci 2021; 22: 4713.
doi: 10.3390/ijms22094713 |
| [24] |
Kim MM, Parmar HA, Schipper M, Devasia T, Aryal MP, Kesari S, et al. BRAINSTORM: a multi-institutional phase 1/2 study of RRx-001 in combination with whole brain radiation therapy for patients with brain metastases. Int J Radiat Oncol Biol Phys 2020; 107: 478-486.
doi: 10.1016/j.ijrobp.2020.02.639 |
| [25] |
Tomita Y, Oronsky B, Abrouk N, Cabrales P, Reid TR, Lee MJ, et al. In small cell lung cancer patients treated with RRx-001, a downregulator of CD47, decreased expression of PD-L1 on circulating tumor cells significantly correlates with clinical benefit. Transl Lung Cancer Res 2021; 10: 274-278.
doi: 10.21037/tlcr-20-359 |
| [26] |
Lee MJ, Tomita Y, Yuno A, Lee S, Abrouk NE, Oronsky B, et al. Results from a biomarker study to accompany a phase II trial of RRx-001 with reintroduced platinum-based chemotherapy in relapsed small cell carcinoma. Expert Opin Investig Drugs 2021; 30: 177-183.
doi: 10.1080/13543784.2021.1863947 |
| [27] |
Ratner M. Genentech discloses safety concerns over Avastin. Nat Biotechnol 2004; 22: 1198.
doi: 10.1038/nbt1004-1198 |
| [28] |
Hu X, Liu H, Ye M, Zhu X. Prognostic value of microvessel density in cervical cancer. Cancer Cell Int 2018; 18: 152.
doi: 10.1186/s12935-018-0647-3 |
| [29] |
Wang H, Lutz AM, Hristov D, Tian L, Willmann JK. Intra-animal comparison between three-dimensional molecularly targeted US and three-dimensional dynamic contrast-enhanced US for early antiangiogenic treatment assessment in colon cancer. Radiology 2017; 282: 443-452.
doi: 10.1148/radiol.2016160032 |
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