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Cancer Biology and Genetics for Non-Biologists
Published in Trevor F. Cox, Medical Statistics for Cancer Studies, 2022
Next, we need a measure of a tumour's response to treatment. The RECIST (Response Evaluation Criteria In Solid Tumours) guidelines suggest how the response should be measured. Table 2.2 outlines the possible responses, but these will depend on the cancer type and tumours and the number of lesions (areas of abnormal tissue).
Challenges in Cancer Clinical Trials
Published in Wei Zhang, Fangrong Yan, Feng Chen, Shein-Chung Chow, Advanced Statistics in Regulatory Critical Clinical Initiatives, 2022
Endpoints like PFS and ORR are based on tumor response measurements from imaging data. For assessment of imaging-based tumor response data, standard response criteria have been proposed. For solid tumors, the Response Evaluation Criteria in Solid Tumor (RECIST) has been uniformly adopted to evaluate tumor changes, to suggest overall response destinations at each tumor imaging assessment, and finally to conclude the Best Overall Response (BOR) level achieved. The RECIST was first published in 2000 (Therasse et al. 2000) and the latest revision was made in 2009 as version v1.1 (Eisenhauer et al. 2009). For lymphoma staging and tumor response evaluation, the LUGANO classification criteria (Cheson et al. 2014), which incorporates PET-CT as a standard component for FDG-avid lymphomas while retaining CT evaluation for other lymphomas subtypes, is the most commonly used criteria in clinical practice. Recently, both RECIST and LUGONA criteria have been adapted for immune-based treatment (Cheson et al. 2016, Seymour et al. 2017).
Small-Molecule Targeted Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Despite the advent of many new classes of highly effective anticancer agents during the past decade, including the immunotherapies which have caused much excitement, the majority of patients with high-risk or advanced-stage cancers continue to die through metastatic disease. Thus, improvements in the survival of patients with cancer over time through innovations within the pharmaceutical industry have not equally benefited those with metastatic disease. One potential reason for this is that anticancer drug development generally relies on the demonstration of tumor shrinkage according to RECIST (Radiological Response Evaluation Criteria for Solid Tumors) criteria which ignore any metastatic aspects of the disease. Only after tumor responses and/or improvements in patient survival have been demonstrated will a new agent be evaluated for its ability to prevent or delay metastatic disease. Consequently, there is still little clinical research undertaken on agents that can moderate the biological mechanisms underlying the metastatic process.
Hyperthermia in the treatment of high-risk soft tissue sarcomas: a systematic review
Published in International Journal of Hyperthermia, 2023
Paraskevi Danai Veltsista, Eva Oberacker, Adela Ademaj, Stefanie Corradini, Franziska Eckert, Anne Flörcken, David Kaul, Lars H. Lindner, Rolf Issels, Oliver J. Ott, Daniel Pink, Vlatko Potkrajcic, Peter Reichardt, Siyer Roohani, Mateusz Jacek Spalek, Oliver Riesterer, Daniel Zips, Pirus Ghadjar
Specifically, seven patients exhibited complete and two partial responses, whereas six patients remained local-failure-free (LFF) until death. Complete response was defined as elimination of all lesions, while partial response referred to a 30% decrease in the sum of greatest dimensions of the target lesions according to Response Evaluation Criteria in Solid Tumors (RECIST). Patients were treated in two cancer centers (Academic Medical Center - AMC and the Institute Verbeeten - BVI). The total RT dose at the AMC was 32 Gy (8 × 4 Gy) given twice per week for 4 weeks while at the BVI, patients received a total dose of 36 Gy (12 × 3 Gy) 4 times per week. RT was combined with SHT applied by microstrip applicators and the temperatures were measured superficially. The high response rate (75%) indicates that the combination of re-RT plus SHT in this approach leads to durable LC, and it can serve as a dynamic solution to a condition as rare as RAS sarcomas.
Trabectedin-irinotecan, a potentially promising combination in relapsed desmoplastic small round cell tumor: report of two cases
Published in Journal of Chemotherapy, 2023
Andrea Ferrari, Stefano Chiaravalli, Luca Bergamaschi, Olga Nigro, Virginia Livellara, Giovanna Sironi, Patrizia Gasparini, Sandro Pasquali, Nadia Zaffaroni, Silvia Stacchiotti, Carlo Morosi, Maura Massimino, Michela Casanova
The first patient received 6 courses of trabectedin and irinotecan. Radiological examination after 3 cycles showed a mixed response, with tumor shrinkage of the patient’s pulmonary and peritoneal lesions (from 17 mm and 32 mm at baseline, to 14 mm and 25 mm, respectively) and progression of his liver metastases (from 15 mm and 17 mm, to 38 mm and 20 mm, respectively) (Figure 1). According to RECIST criteria, this was considered a stable disease (19.7% increase, not sufficient to qualify for progressive disease). Also for the absence of valid alternative therapeutic options, 3 further cycles of trabectedin and irinotecan were administered. The new assessment after 6 courses revealed tumor progression at all disease sites, so the treatment was discontinued. After further treatment (prolonged 14-day continuous infusion of high-dose ifosfamide) achieved no response, the patient died of his tumor, 58 months after it was first diagnosed.
Yttrium-90 for colorectal liver metastasis - the promising role of radiation segmentectomy as an alternative local cure
Published in International Journal of Hyperthermia, 2022
Pouya Entezari, Ahmed Gabr, Riad Salem, Robert J. Lewandowski
Most recently, Kurilova et al. evaluated the safety and efficacy of radiation segmentectomy with glass microspheres in patients with limited hepatic metastases [57]. Ten patients with metastatic liver disease deemed not candidates for surgery or thermal ablation, including 2 patients with colorectal origin of metastasis, were included. These patients were treated with ablative tumor targeting (190 Gy), with actual delivered radiation dose to the tumor (MIRD dosimetry) ranging from 163 to 1303 Gy. Based on RECIST 1.1 and Choi criteria, 44 and 100% of patients had partial or complete tumor response, respectively. With a median follow-up of 17.8 months, overall LTP was 21% and the rate of disease progression in the treated segment was 33%. Of two CRLM patients, one had LTP at 4.9 months [57]. The other patient received two treatment sessions and had no tumor progression on the last follow-up visit at 35 months. The one-, two-, and three-year LTP-free survival (LTPFS) was 83, 83, and 69%, respectively, and the median LTPFS was not reached. The median OS was 41.5 months in the entire cohort and three-year OS rate was 74%. Adverse events, reported in 50% of the procedures, were mainly self-limiting. One major complication was observed in a patient with history of prior Whipple surgery who developed biloma and liver abscess 6.5 months after undergoing radiation segmentectomy, requiring hospitalization and abscess aspiration [57].