Korean J Radiol.  2010 Dec;11(6):618-626. 10.3348/kjr.2010.11.6.618.

Molecularly Targeted Therapy Using Bevacizumab for Non-Small Cell Lung Cancer: a Pilot Study for the New CT Response Criteria

• Lee HY
• Lee KS
• Hwang HS
• Lee JW
• Ahn MJ
• Park K
• Kim TS
• Yi CA
• Chung MJ

• KMID: 1119224
• DOI: http://doi.org/10.3348/kjr.2010.11.6.618

Abstract

OBJECTIVE
We wanted to compare the efficacy of the new CT response evaluation criteria for predicting the tumor progression-free survival (PFS) with that of RECIST 1.1 in non-small cell lung cancer (NSCLC) patients who were treated with bevacizumab.
MATERIALS AND METHODS
Sixteen patients (M:F = 11:5; median age, 57 years) treated with bevacizumab and combined cytotoxic chemotherapeutic agents were selected for a retrospective analysis. The tumor response was assessed by four different methods, namely, by using RECIST 1.1 (RECIST), RECIST but measuring only the solid component of tumor (RECISTsolid), the alternative method reflecting tumor cavitation (the alternative method) and the combined criteria (the combined criteria) that evaluated both the changes of tumor size and attenuation. To evaluate the capabilities of the different measurement methods to predict the patient prognosis, the PFS were compared, using the log rank test, among the responder groups (complete response [CR], partial response [PR], stable disease [SD] and progressive disease [PD]) in terms of the four different methods.
RESULTS
The overall (CR, PR or SD) response rates according to RECIST, RECISTsolid, the alternative method and the combined criteria were 81%, 88%, 81% and 85%, respectively. The confirmed response rates (CR or PR) were 19%, 19%, 50% and 54%, respectively. Although statistically not significant, the alternative method showed the biggest difference for predicting PFS among the three response groups (PR, SD and PD) (p = 0.07). RECIST and the alternative method showed a significant difference for predicting the prognosis between the good (PR or SD) and poor overall responders (p = 0.02).
CONCLUSION
The response outcome evaluations using the three different CT response criteria that reflect tumor cavitation, the ground-glass opacity component and the attenuation changes in NSCLC patients treated with bevacizumab showed different results from that with using the traditional RECIST method.

Keyword

Targeted therapy; Tumor response assessment; Response criteria; Guideline, Non-small cell lung cancer

MeSH Terms

Angiogenesis Inhibitors/*therapeutic use
Antibodies, Monoclonal/*therapeutic use
Carcinoma, Non-Small-Cell Lung/*drug therapy/pathology/*radiography
Disease Progression
Female
Humans
Lung Neoplasms/*drug therapy/pathology/*radiography
Male
Middle Aged
Pilot Projects
Prognosis
Radiographic Image Interpretation, Computer-Assisted
Retrospective Studies
Salvage Therapy
Survival Rate
*Tomography, X-Ray Computed
Treatment Outcome

Figure

• 

  Fig. 1 RECIST versus RECIST for measuring only solid portion (RECISTsolid). A. Diagram depicting target lesion measurement by RECIST and RECISTsolid. B, C. Solid component within partly solid nodule has disappeared after treatment, but ground-glass component of lesion is still remaining (patient No. 8).

• 

  Fig. 2 Response evaluation using alternative method. A. Diagram depicting target lesion measurement by RECIST and alternative method. B, C. CT images demonstrating pulmonary cavitation after two cycles of Bevacizumab-containing chemotherapy; CT images at baseline (B) and after two cycles of bevacizumab (C). There is no residual solid component within lesion. Tumor response was assessed as stable disease according to traditional RECIST. In contrast, it corresponds to partial response by alternative method (patient No. 9).

• 

  Fig. 3 Progression free survival in subgroups of partial response, stable disease and progressive disease according to each response criterion. Although it was not statistically significant, prediction of response to vascular inhibitor therapy was better with using alternative method (p = 0.07) than with using RECIST, RECISTsoild or combined criteria. PD = progressive disease, PFS = progression-free survival, PR = partial response, SD = stable disease

• 

  Fig. 4 Progression free survival in good and poor responders by each response criterion. Although it was not statistically significant, prediction of response to vascular inhibitor therapy was better with using alternative method (p = 0.09) than with using RECIST, RECISTsoild or combined criteria. PFS = progression-free survival

• 

  Fig. 5 Progression free survival in good and poor overall responders by each response criterion. RECIST and alternative method show significant difference for predicting prognosis between good and poor overall responders (p = 0.02). PFS = progression-free survival

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