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Targeted-therapy and imaging response: a new paradigm for clinical evaluation?
Amalia Milano1, Francesco Perri, Andrea Ciarmiello
1San Bartolomeo Hospital, Sarzana (SP), Italy. amalia.milano@as15.liguria.it
Abstract:
Clinical management of patients with malignant tumors has dramatically changed over the last years with the introduction of novel therapeutics, such as receptor-targeted therapies, downstream effectors and antiangiogenic compounds. This has created a need to re-evaluate the existing criteria used to assess treatment response. Emerging diagnostic techniques, combining functional and structural data may play a relevant role in planning new treatment strategies in individual cancer patients. In the new scenario where biological treatment results in stable disease, standard Response Evaluation Criteria in Solid Tumors (RECIST) and RECIST 1.1 criteria have limitations. Moreover, functional 18- fluorodeoxyglucose ((18)FDG)-positron emission tomography (PET) imaging provides an additional tool to assess tumor activity, particularly consistent in some settings, such as Gastro Intestinal Solid Tumors (GIST), hepatocarcinoma, nonsmall lung cancer, and colorectal cancer. The integration of (18)FDG-PET and computed tomography (CT) enhances the evaluation of oncologic patients treated with molecularly targeted drugs, and accelerates drug development in many types of tumors.
Insights
Novel cancer therapies require updated response assessment. Integrating functional (18)fluorodeoxyglucose-positron emission tomography (18FDG-PET) with structural imaging improves evaluation of treatment response in solid tumors.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Recent advancements in cancer therapeutics, including targeted therapies and antiangiogenic compounds, necessitate re-evaluation of existing treatment response assessment criteria.
- Standard criteria like Response Evaluation Criteria in Solid Tumors (RECIST) and RECIST 1.1 show limitations in assessing treatment effectiveness, particularly when biological treatments result in stable disease.
Purpose of the Study:
- To highlight the limitations of current RECIST criteria in the context of novel cancer therapies.
- To emphasize the role of emerging diagnostic techniques, specifically functional imaging, in cancer patient management and drug development.
Main Methods:
- Review of current clinical management strategies for malignant tumors.
- Discussion of the utility of functional imaging, such as 18-fluorodeoxyglucose-positron emission tomography ((18)FDG-PET), in assessing tumor activity.
- Exploration of the integration of (18)FDG-PET with computed tomography (CT) for enhanced patient evaluation.
Main Results:
- Novel therapeutics have outpaced traditional response evaluation criteria, revealing limitations in RECIST and RECIST 1.1.
- (18)FDG-PET imaging offers a valuable tool for assessing tumor activity, showing consistency in specific cancers like GIST, hepatocarcinoma, non-small cell lung cancer, and colorectal cancer.
- The combined use of (18)FDG-PET and CT improves the assessment of oncologic patients undergoing molecularly targeted drug treatments.
Conclusions:
- There is a critical need to re-evaluate and potentially update response assessment criteria to align with modern cancer therapeutics.
- (18)FDG-PET/CT integration offers a superior method for evaluating treatment response and accelerating drug development in various solid tumors.
- Functional and structural imaging integration is crucial for personalized treatment strategies and improved outcomes in cancer patients.
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