RECIST 1.1, Choi and mChoi criteria in the evaluation of tumor response in patients with metastatic colorectal cancer treated with Regorafenib and anti-PD-1 antibody

A pilot study of volumetric and density tumor analysis of ACC patients treated with vorinostat in a phase II clinical trial

Rationale and objectives

Adenoid cystic carcinoma (ACC) is a rare salivary gland cancer. The vast majority of clinical trials evaluating systemic therapy efficacy in solid tumors use the Response Evaluation Criteria in Solid Tumors (RECIST) to measure response that is limited to 2 dimensional only evaluations, not taking volume or density into account. The indolent behavior ACC represents a challenge toward an appropriate evaluation of therapy response. Objectives: 1) To describe and contrast volumetric and density changes at each time-point, including changes noted from baseline to best response, to currently used 2 dimensional-only criteria (RECIST) and 2) To report the coefficient of variation in volume measurement among three reviewers on a subset of ACC patients.

Materials and methods

We retrospectively assessed a cohort of 18 prospectively treated patients with ACC in a phase 2 trial with vorinostat using a volumetric (viable tumor volume, VTV) and density criteria. Three independent and blinded observers segmented target lesions across a sample of randomly selected computed tomography (CT) exams to examine inter-observer variation.

Results

We found that the average coefficient of variation among observers for all target lesions was 16.1%, with lung lesions displaying a smaller variation at 14.0% (p-value >0.17). We describe examples of decrease in volume and density in several lesions despite stable disease by RECIST.

Conclusion

This pilot study demonstrates that two-dimensional criteria such as RECIST may not be the best criteria to assess response to therapy, especially with evolving tools within picture archiving and communication system (PACS) that can assess volumetric size, density and texture, however, this should be prospectively studied.

Camrelizumab and Apatinib Combined with Radiotherapy Is Effective in Advanced Oligometastatic Non-Small-Cell Lung Cancer

Objective. To investigate the effect of camrelizumab + apatinib combined with radiotherapy on the expression of TRIM27, SCC-Ag, and CYFRA21-1 in advanced oligometastatic non-small-cell lung cancer (NSCLC). Methods. A retrospective analysis of patients with oligometastatic NSCLC who were treated at our hospital from January 1, 2021, to March 31, 2022. Patients who met the inclusion criteria were summarized into an observation group (camrelizumab on the basis of the control group), or a control group (radiotherapy combined with oral apatinib). The disease control rate, immune function, changes in the levels of TRIM27, SCC-Ag, CYFRA21-1, and the occurrence of adverse effects were compared between the two groups. Result. There were 86 patients who met the inclusion criteria, with 53 cases in the observation group and 33 cases in the control group. There were significant differences in complete remission (CR, 25/53 vs. 10/33), partial remission (PR, 17/53 vs. 12/33), disease control (DC, 7/53 vs. 4/33), disease progression (DP, 4/53 vs. 7/33), and disease control rate (49/53 vs. 26/33) between the observation group and the control group. There was no significant difference in immune function between the two groups before treatment ( $p>0.05$ ). After treatment, the levels of CD3+, CD4+, CD4+/CD8+t cells, and NK cells in the observation group were higher ( $p=0.015$ , 0.035, 0.003, 0.001, respectively), while the level of CD8+t cells was lower ( $p<0.001$ ). There were no significant differences in TRIM27, SCC-Ag, or CYFRA21-1 between the two groups before treatment ( $p>0.05$ ). After treatment, the observation group had lower levels of TRIM27 ( $p=0.035$ ), SCC-Ag ( $p=0.045$ ), and CYFRA21-1 ( $p=0.003$ ). There was no significant difference in the occurrence of adverse events between the two groups ( $p<0.05$ ). Conclusion. Treatment of camrelizumab + apatinib combined with radiotherapy is effective for advanced oligometastatic NSCLC, with mild adverse effects.

Gut microbiota composition in chemotherapy and targeted therapy of patients with metastatic colorectal cancer

Studies have reported the effects of the gut microbiota on colorectal cancer (CRC) chemotherapy, but few studies have investigated the association between gut microbiota and targeted therapy. This study investigated the role of the gut microbiota in the treatment outcomes of patients with metastatic CRC (mCRC). We enrolled 110 patients with mCRC and treated them with standard cancer therapy. Stool samples were collected before administering a combination of chemotherapy and targeted therapy. Patients who had a progressive disease (PD) or partial response (PR) for at least 12 cycles of therapy were included in the study. We further divided these patients into anti-epidermal growth factor receptor (cetuximab) and anti-vascular endothelial growth factor (bevacizumab) subgroups. The gut microbiota of the PR group and bevacizumab-PR subgroup exhibited significantly higher α-diversity. The β-diversity of bacterial species significantly differed between the bevacizumab-PR and bevacizumab-PD groups (P = 0.029). Klebsiella quasipneumoniae exhibited the greatest fold change in abundance in the PD group than in the PR group. Lactobacillus and Bifidobacterium species exhibited higher abundance in the PD group. The abundance of Fusobacterium nucleatum was approximately 32 times higher in the PD group than in the PR group. A higher gut microbiota diversity was associated with more favorable treatment outcomes in the patients with mCRC. Bacterial species analysis of stool samples yielded heterogenous results. K. quasipneumoniae exhibited the greatest fold change in abundance among all bacterial species in the PD group. This result warrants further investigation especially in a Taiwanese population.

Different Radiological Criteria for Early Tumor Response Evaluation in Patients With Unresectable Hepatocellular Carcinoma Treated With Anti-PD-1 Antibody Plus Bevacizumab

Purpose

We aimed to compare different radiological criteria in evaluating the early tumor response of patients with unresectable hepatocellular carcinoma (uHCC) treated with an anti-programmed cell death protein 1 (PD-1) antibody plus bevacizumab.

Method

From October 2018 to January 2020, 58 patients [49 (84.5%) men, age = 55.2 ± 10.6 years] receiving both anti-PD-1 antibody and bevacizumab were retrospectively included. Pre- and the first posttreatment contrast-enhanced computed tomography (CE-CT) scans were performed in all patients. The Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1), modified RECIST (mRECIST), Choi, and the revised Choi (rChoi) criteria were applied to evaluate tumor response. The endpoint event was defined as overall survival (OS).

Results

Six (10.3%), 9 (15.5%), 30 (51.7%), and 12 (20.7%) patients were diagnosed as responders by RECIST 1.1, mRECIST, Choi, and rChoi, respectively. The RECIST 1.1 and mRECIST criteria failed to correlate the evaluation categories with OS (p = 0.130 and 0.253, respectively), while both Choi and rChoi significantly correlated with OS (p = 0.002 and 0.006, respectively). Among the four criteria, only those patients identified as responders by Choi (p = 0.0005) and rChoi (p = 0.005) showed significantly better OS than the non-responders. The cumulative 1- and 2-year OS rates by Choi were 93.3% and 79.8% in responders and 69.3% and 30.3% in non-responders, respectively; these rates were 100.0% and 100.0% in responders and 74.9% and 43.1% in non-responders by rChoi, respectively.

Conclusions

The evaluation of early tumor response using Choi and rChoi instead of RECIST 1.1 and mRECIST significantly correlated with the OS of patients with uHCC treated with an anti-PD-1 antibody plus bevacizumab. Moreover, patients identified as responders by Choi and rChoi showed significantly better OS than the non-responders.