Alternative Response Criteria (Choi, European Association for the Study of the Liver, and Modified Response Evaluation Criteria in Solid Tumors [RECIST]) Versus RECIST 1.1 in Patients With Advanced Hepatocellular Carcinoma Treated With Sorafenib

Abstract

Introduction. Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1), may underestimate activity and does not predict survival in patients with hepatocellular carcinoma (HCC) treated with sorafenib. This study assessed the value of alternative radiological criteria to evaluate response in HCC patients treated with sorafenib. Patients and Methods. A retrospective blinded central analysis was performed of computed tomography (CT) scans from baseline and the first tumor evaluation in consecutive patients treated with sorafenib over a 2‐year period in a single institution. Four different evaluation criteria were used: Choi, European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), and RECIST 1.1. Results. Among 82 HCC patients, 64 with Barcelona Clinic Liver Cancer stage B‐C were evaluable with a median follow‐up of 22 months. Median duration of sorafenib treatment was 5.7 months, and median overall survival was 12.8 months. At the time of the first CT scan, performed after a median of 2.1 months, Choi, EASL, mRECIST, and RECIST 1.1 identified 51%, 28%, 28%, and 3% objective responses, respectively. Responders by all criteria showed consistent overall survival >20 months. Among patients with stable disease according to RECIST 1.1, those identified as responders by Choi had significantly better overall survival than Choi nonresponders (22.4 vs. 10.6 months; hazard ratio: 0.43, 95% confidence interval: 0.15–0.86, p = .0097). Conclusion. Choi, EASL, and mRECIST criteria appear more appropriate than RECIST 1.1 to identify responders with long survival among advanced HCC patients benefiting from sorafenib.

Significance of different response evaluation criteria in predicting progression‐free survival of lung cancer with certain imaging characteristics

“…proposed using a combination of tumor size and density (HU) to produce modified criteria 7. This criterion was promoted as an early response predictor in patients with metastatic malignant melanoma treated with vemurafenib and to predict long‐term prognosis in patients with advanced hepatocellular carcinoma treated with sorafenib 14, 15…”

Disease control with sunitinib in advanced intrahepatic cholangiocarcinoma resistant to gemcitabine-oxaliplatin chemotherapy

“…The most common evaluation criteria (RECIST) are based exclusively on tumor size. Other composite criteria, such as the Choi criteria, provide an alternative as they consider both tumor size and tumor density, particularly as anti-angiogenic agents may render a tumor hypodense without size modification [21,22] . However, these criteria require validation in large patient cohorts.…”

A comparative study of chemotherapy combined with intermittent microwave ablation and chemotherapy in the treatment of oligometastatic non-small cell lung cancer

“…Chest CT was conducted 1 month after microwave ablation, and the whole-abdominal and chest CT were reviewed at 1, 3, and 6 months after treatment. Simultaneously, CT enhanced scan was used to evaluate the activity of the lesions, and the efficacy was evaluated objectively according to the modified Response Evaluation Criteria in Solid Tumors (mRICIST) [10].…”

“…Microwave ablation therapy has its unique A comparative study of chemotherapy combined with intermittent microwave ablation and chemotherapy in the treatment of oligometastatic non-small cell lung cancer safety, minimally invasive and effective advantages in the treatment of malignant tumors. Microwave ablation combined with chemical therapy has gradually become one of the important means of clinical treatment of nonsmall cell lung cancer (NSCLC) [10].…”