Evaluation of Lung Cancer Response

1) To understand the applicability of anatomic imaging using World Health Organization (WHO) criteria and Response Evaluation Criteria in Solid Tumors (RECIST 1.1) in the assessment of tumor response in patients with non-small cell lung cancer (NSCLC). 2) To be aware of the limitations of World Health Organization (WHO) criteria and Response Evaluation Criteria in Solid Tumors (RECIST 1.1) in the assessment of tumor response. 3) To understand the potential role of metabolic tumor response assessment with 18F-FDG PET (PET Response Criteria in Solid Tumors (PERCIST)) in patients with NSCLC.

NSCLC commonly presents with advanced disease and chemotherapy is often an integral component in;treatment. However, following initiation of chemotherapy, tumor progression can occur in up to 33% of patients. Early determination of this therapeutic failure can be important in management and can assist clinical decisions concerning discontinuation of ineffective treatment and institution of alternative therapy. Additionally, an essential component of evaluating the results of cancer treatment in patients on clinical trials is the reporting of the response rate. Because small differences in the response rate can affect the outcome clinical trials, it is important that the criteria used to make this determination are meaningful and consistent. While the antitumor effect of a treatment in patients with solid tumors can be determined clinically or by surgical pathologic re-staging, image-based serial measurements based on WHO criteria or Response Evaluation Criteria in Solid Tumors (RECIST) provide uniform criteria for reporting response. However, morphological alterations detected by CT may not correlate with pathological response and tumor viability. Furthermore, the assessment of objective response has also been complicated by the development of treatment protocols that target tumor biology including tumor cell proliferation and invasion, angiogenesis and metastasis. Anti-tumor effect in many of these regimens is cytostatic and, unlike anticancer cytotoxic agents, may not cause regression in tumor size. FDG-PET may allow an early and sensitive assessment of the effectiveness of anticancer chemotherapy as FDG uptake is not only a function of proliferative activity but is also related to viable tumor cell number. This talk will review the status and limitations of anatomic and metabolic tumor response metrics in NSCLC including WHO criteria, RECIST 1.1 and PET Response Criteria in Solid Tumors (PERCIST).

RC218D

Evaluation of Lung Cancer Response