SlideShare a Scribd company logo
AASLD 2011




BLINDED INDEPENDENT CENTRAL RESPONSE ASSESSMENT
   USING RECIST, MODIFIED RECIST, AND CHOI CRITERIA
 IN PATIENTS TREATED WITH SORAFENIB FOR ADVANCED
            HEPATOCELLULAR CARCINOMA



    Mohamed Bouattour, Johanna Wassermann, Onorina Bruno,
 Béatrice Larroque, Laurent Castera, Chantal Dreyer, Valérie Vilgrain,
          Jacques Belghiti, Eric Raymond, Sandrine Faivre

                 Beaujon University Hospital
                       Clichy, France
AASLD 2011




No disclosure to declare
RECIST do Not Capture the True Benefit of
              Sorafenib in HCC

• Sorafenib improves survival but yields low objective
  response rate by RECIST (< 5%)1,2

• Sustained survival despite NO response by RECIST
  suggest that RECIST are inappropriate to capture the true
  benefit of sorafenib3

• Modified RECIST (mRECIST)4 are used to assess vascular
  effects of TACE5 and CHOI criteria were proposed to
  evaluate necrosis induced by targeted agents in HCC6

   1 LlovetJM ; N Engl J Med 2008                4 Lencioni R ; Semin Liver Dis. 2010
   2 Cheng AL ; Lancet Oncol 2009                5 Gillmore R, J Hepatol 2011
   3 Edeline J, Cancer 2011                      6 Faivre S, Clin Cancer Res 2011
                                    AASLD 2011
Objectives


• At the first tumor evaluation, are mRECIST and CHOI
  criteria predicting overall survival in patients with
  HCC treated with sorafenib?

• Can mRECIST and CHOI criteria reallocate to the
  objective response group, patients who were
  inappropriately considered non-responders by
  RECIST?



                         AASLD 2011
Study Method/Radiological Evaluation


• Retrospective single center cohort analysis
• January 2007- December 2009
• Beaujon Hospital

• Baseline evaluation within 6 weeks prior to sorafenib
• First tumor evaluation by CT-scan 2-3 months after
  sorafenib initiation




                         AASLD 2011
Radiological Evaluation

• Quality control criteria
   – Multiphasic CT-scan fully available for central review
   – Central Review of data by a radiologist highly experienced in
     liver cancers, blinded to clinical data
   – Evaluation of tumor response by RECIST, mRECIST, and CHOI
     criteria


     RECIST               mRECIST                CHOI criteria


                                                     HU




                             AASLD 2011
Results: Study Population Selection

 Patients with BCLC B-C, Child-Pugh A-B, advanced
  hepatocellular carcinoma treated with sorafenib
                 from 2007 to 2009
                       (n=82)



                                          Non-evaluable patients (n=22)
                                            –   Non-evaluable CT scan (n=9)
                                            –   Target lesions in pretreated area (n=9)
                                            –   No target lesion (n=3)
                                            –   Missing data (n=4)
                                                  •   Lost of follow up
                                                  •   Early death




Patients evaluated in this study
             (n=60)

                             AASLD 2011
Patient Characteristics
Median age, years                                           61 (37-77)

Sex M/F                                                       52/8

Etiology, % (number of patients)
     Viral                                                   48 (29)
     Alcohol                                                 23 (14)
Child Pugh Score, % (number of patients)
      A                                                      80 (48)
      B                                                      20 (12)
BCLC stage , % (number of patients)
    B                                                        33 (20)
    C                                                        67 (40)
Pathological diagnosis, % (number of patients)               88 (53)

Extrahepatic Spread , % (number of patients)                 35 (21)

Prior treatments, % (number of patients)
      None                                                   32 (19)
      Surgery                                                27 (16)
      Radio Frequency Ablation                                5 (3)
      Trans-Arterial Chemo-Embolization                      36 (22)
Median duration of sorafenib, months                           5.7

Median time for the first evaluation, months                   2.1
                                               AASLD 2011
mRECIST and CHOI Criteria Identify
  More Responder Patients Than RECIST

Venn diagram of tumor response according to three criteria




      15       10      2                RECIST n=2

                                mRECIST n=12

                    CHOI criteria n=27
                           AASLD 2011
Response Rates by
                                            RECIST, mRECIST, and CHOI Criteria

                                       70                                                  Objective response
% of response rates by each criteria




                                       60                                                  Stable Disease
                                                  62                                       Progressive Disease
                                       50

                                       40                         48
                                                                                45
                                       30
                                                       35                                 32
                                                                       30
                                       20
                                                                                     23
                                                             21
                                       10
                                              3
                                        0
                                             RECIST         mRECIST             CHOI
                                              N=60           N=56* AASLD 2011   N=60           *4 pts non evaluable
At the first tumor evaluation, are mRECIST
and CHOI criteria predicting overall survival
in patients with HCC treated with sorafenib?




                   AASLD 2011
Responses by RECIST Criteria Correlate with
                                         Survival

                            1


                           0,9


                           0,8                              RECIST
Probability of survival




                           0,7


                           0,6                                                                 Objective response (PR/CR)
                           0,5
                                                                                               Stable Disease
                                                                                               Progressive Disease
                           0,4


                           0,3


                           0,2


                           0,1
                                     p=0.0012
                            0
                                 0       5      10   15    20    25    30       35   40   45




                                                 Duration of survival, months
Can mRECIST and CHOI criteria reallocate
to the objective response group, patients
who were inappropriately considered non-
        responders by RECIST?




                 AASLD 2011
Examples of discrepancies
Between methods of evaluation      RECIST             mRECIST    CHOI criteria

             Baseline            Stable             Response    Response




                                                                  ↘ HU




             Baseline            Progression  Response          Response




                                                                         ↘ HU




                                       AASLD 2011
Many Stable and Some Progressive Diseases
                                                by RECIST Are Objective Responses
                                                   by mRECIST and CHOI Criteria
                                              Objective responses according to each criteria


                                                                                     45%
Number of patients with objective response




                                              30
                                                                                       3
                                              25                                                    Response by RECIST
                                                                                                       Progressive Disease
                                              20                       21.4%
                                              15                                      22               Stable Disease
                                                                        1
                                                                                                       Objective response
                                              10
                                                           3.3%
                                                                        9
                                              5
                                                           2            2             2
                                              0
                                                   Responders      Responders      Responders
                                                   RECIST (n=2)                 AASLD 2011 (n=27)
                                                                  mRECIST (n=12) CHOI
Conclusion

• Response rate using mRECIST and CHOI criteria correlates
  with survival in advanced HCC patients treated with
  sorafenib

• mRECIST and CHOI criteria identify patients with true
  benefit (partial responders with higher survival) among
  “RECIST-stable” and “RECIST-progressive” patients

• mRECIST and CHOI criteria compared to RECIST increase the
  number of partial responders who also are patients with a
  median overall survival >14 months

                            AASLD 2011

More Related Content

What's hot

20131222 TASL HBV pre-S deletion mutants and HCC outcomes
20131222 TASL HBV pre-S deletion mutants and HCC outcomes 20131222 TASL HBV pre-S deletion mutants and HCC outcomes
20131222 TASL HBV pre-S deletion mutants and HCC outcomes
Chien-Wei Su
 
Endoscopy in Gastrointestinal Oncology - Slide 9 - P.G. Arcidiacono - EUS in ...
Endoscopy in Gastrointestinal Oncology - Slide 9 - P.G. Arcidiacono - EUS in ...Endoscopy in Gastrointestinal Oncology - Slide 9 - P.G. Arcidiacono - EUS in ...
Endoscopy in Gastrointestinal Oncology - Slide 9 - P.G. Arcidiacono - EUS in ...
European School of Oncology
 
Sbrt liver tumors_kag(cancer ci 2013) karyn a. goodman
Sbrt liver tumors_kag(cancer ci 2013) karyn a. goodmanSbrt liver tumors_kag(cancer ci 2013) karyn a. goodman
Sbrt liver tumors_kag(cancer ci 2013) karyn a. goodman
Dr. Vijay Anand P. Reddy
 

What's hot (20)

20131222 TASL HBV pre-S deletion mutants and HCC outcomes
20131222 TASL HBV pre-S deletion mutants and HCC outcomes 20131222 TASL HBV pre-S deletion mutants and HCC outcomes
20131222 TASL HBV pre-S deletion mutants and HCC outcomes
 
Guideline Development Discussion
Guideline Development DiscussionGuideline Development Discussion
Guideline Development Discussion
 
Research Discussion
Research DiscussionResearch Discussion
Research Discussion
 
MCC 2011 - Slide 27
MCC 2011 - Slide 27MCC 2011 - Slide 27
MCC 2011 - Slide 27
 
Controversies in hepato-biliary surgery
Controversies in hepato-biliary surgery Controversies in hepato-biliary surgery
Controversies in hepato-biliary surgery
 
Stereotactic Ablative Radiotherapy for Liver Cancer: Report from Tri-Service...
Stereotactic Ablative Radiotherapy for Liver Cancer: Report from Tri-Service...Stereotactic Ablative Radiotherapy for Liver Cancer: Report from Tri-Service...
Stereotactic Ablative Radiotherapy for Liver Cancer: Report from Tri-Service...
 
Clinical Experiences of CK/HT in Hepatocellular Carcinoma
Clinical Experiences of CK/HT in Hepatocellular CarcinomaClinical Experiences of CK/HT in Hepatocellular Carcinoma
Clinical Experiences of CK/HT in Hepatocellular Carcinoma
 
Endoscopy in Gastrointestinal Oncology - Slide 9 - P.G. Arcidiacono - EUS in ...
Endoscopy in Gastrointestinal Oncology - Slide 9 - P.G. Arcidiacono - EUS in ...Endoscopy in Gastrointestinal Oncology - Slide 9 - P.G. Arcidiacono - EUS in ...
Endoscopy in Gastrointestinal Oncology - Slide 9 - P.G. Arcidiacono - EUS in ...
 
Angiogenic blockade and Tomotherapy in hepatocellular carcinoma
Angiogenic blockade and Tomotherapy in hepatocellular carcinomaAngiogenic blockade and Tomotherapy in hepatocellular carcinoma
Angiogenic blockade and Tomotherapy in hepatocellular carcinoma
 
From Binge Drinking to Alcoholic Liver Disease - Du Binge Drinking à l'Hépati...
From Binge Drinking to Alcoholic Liver Disease - Du Binge Drinking à l'Hépati...From Binge Drinking to Alcoholic Liver Disease - Du Binge Drinking à l'Hépati...
From Binge Drinking to Alcoholic Liver Disease - Du Binge Drinking à l'Hépati...
 
Costo efficacia della terapia con sorafenib nel trattamento dell’HCC - Gastro...
Costo efficacia della terapia con sorafenib nel trattamento dell’HCC - Gastro...Costo efficacia della terapia con sorafenib nel trattamento dell’HCC - Gastro...
Costo efficacia della terapia con sorafenib nel trattamento dell’HCC - Gastro...
 
Fecal Occult Blood Tests (FOBT)
Fecal Occult Blood Tests (FOBT)Fecal Occult Blood Tests (FOBT)
Fecal Occult Blood Tests (FOBT)
 
CyberKnife in Hepatocellular Carcinoma
CyberKnife in Hepatocellular CarcinomaCyberKnife in Hepatocellular Carcinoma
CyberKnife in Hepatocellular Carcinoma
 
Rcc in 2021
Rcc in 2021Rcc in 2021
Rcc in 2021
 
La terapia chirurgica del cancro del pancreas - Gastrolearning®
La terapia chirurgica del cancro del pancreas - Gastrolearning®La terapia chirurgica del cancro del pancreas - Gastrolearning®
La terapia chirurgica del cancro del pancreas - Gastrolearning®
 
Sbrt liver tumors_kag(cancer ci 2013) karyn a. goodman
Sbrt liver tumors_kag(cancer ci 2013) karyn a. goodmanSbrt liver tumors_kag(cancer ci 2013) karyn a. goodman
Sbrt liver tumors_kag(cancer ci 2013) karyn a. goodman
 
British Columbia Medical Journal - May 2010: Liver transplantation: Current s...
British Columbia Medical Journal - May 2010: Liver transplantation: Current s...British Columbia Medical Journal - May 2010: Liver transplantation: Current s...
British Columbia Medical Journal - May 2010: Liver transplantation: Current s...
 
Low Radiation Dose effect of Tomotherapy for Hepatocellular Carcinoma
Low Radiation Dose effect of Tomotherapy for Hepatocellular CarcinomaLow Radiation Dose effect of Tomotherapy for Hepatocellular Carcinoma
Low Radiation Dose effect of Tomotherapy for Hepatocellular Carcinoma
 
COLON CANCER
COLON CANCERCOLON CANCER
COLON CANCER
 
RT for HCC, sunrising or sunset?
RT for HCC, sunrising or sunset?RT for HCC, sunrising or sunset?
RT for HCC, sunrising or sunset?
 

Viewers also liked

Our Experiences by 2016
Our Experiences by 2016Our Experiences by 2016
Our Experiences by 2016
Xiaozhou Ma
 
Clinical response evaluation dr.varun
Clinical response evaluation dr.varunClinical response evaluation dr.varun
Clinical response evaluation dr.varun
Varun Goel
 

Viewers also liked (6)

Response criteria-in-oncologic-imaging
Response criteria-in-oncologic-imagingResponse criteria-in-oncologic-imaging
Response criteria-in-oncologic-imaging
 
Our Experiences by 2016
Our Experiences by 2016Our Experiences by 2016
Our Experiences by 2016
 
Clinical response evaluation dr.varun
Clinical response evaluation dr.varunClinical response evaluation dr.varun
Clinical response evaluation dr.varun
 
Full recist violet
Full recist violetFull recist violet
Full recist violet
 
Comparison of RECIST 1.0 and 1.1 - Impact on Data Management
Comparison of RECIST 1.0 and 1.1 - Impact on Data ManagementComparison of RECIST 1.0 and 1.1 - Impact on Data Management
Comparison of RECIST 1.0 and 1.1 - Impact on Data Management
 
CDISC journey using RECISIT 1.1
CDISC journey using RECISIT 1.1CDISC journey using RECISIT 1.1
CDISC journey using RECISIT 1.1
 

Similar to Radiological evaluation aasld 2011

ABC1 - V. Sacchini - Role of primary site local management for advanced breas...
ABC1 - V. Sacchini - Role of primary site local management for advanced breas...ABC1 - V. Sacchini - Role of primary site local management for advanced breas...
ABC1 - V. Sacchini - Role of primary site local management for advanced breas...
European School of Oncology
 
Poster2 ISRS - Paris 2011
Poster2 ISRS - Paris 2011Poster2 ISRS - Paris 2011
Poster2 ISRS - Paris 2011
Ignacio Sisamon
 
5 understanding some basic trial designs in sarcomas (inclusive a placebo one...
5 understanding some basic trial designs in sarcomas (inclusive a placebo one...5 understanding some basic trial designs in sarcomas (inclusive a placebo one...
5 understanding some basic trial designs in sarcomas (inclusive a placebo one...
James Hilbert
 
Dose Escalation By Imrt And Organ Trackingin Prostate Cancer
Dose Escalation By Imrt And Organ Trackingin Prostate CancerDose Escalation By Imrt And Organ Trackingin Prostate Cancer
Dose Escalation By Imrt And Organ Trackingin Prostate Cancer
fondas vakalis
 
Transarterial chemoembolization in patients with hepatocellular carcinoma
Transarterial chemoembolization in patients with hepatocellular carcinomaTransarterial chemoembolization in patients with hepatocellular carcinoma
Transarterial chemoembolization in patients with hepatocellular carcinoma
mbouattour
 
Sophie Taieb : Breast MRI in neoadjuvant chemotherapy : A predictive respons...
 Sophie Taieb : Breast MRI in neoadjuvant chemotherapy : A predictive respons... Sophie Taieb : Breast MRI in neoadjuvant chemotherapy : A predictive respons...
Sophie Taieb : Breast MRI in neoadjuvant chemotherapy : A predictive respons...
breastcancerupdatecongress
 
Does CD4 Cell Count Influence CT features of Intracranial Opportunistic Infec...
Does CD4 Cell Count Influence CT features of Intracranial Opportunistic Infec...Does CD4 Cell Count Influence CT features of Intracranial Opportunistic Infec...
Does CD4 Cell Count Influence CT features of Intracranial Opportunistic Infec...
hajikareem00
 

Similar to Radiological evaluation aasld 2011 (20)

ABC1 - V. Sacchini - Role of primary site local management for advanced breas...
ABC1 - V. Sacchini - Role of primary site local management for advanced breas...ABC1 - V. Sacchini - Role of primary site local management for advanced breas...
ABC1 - V. Sacchini - Role of primary site local management for advanced breas...
 
Poster2 ISRS - Paris 2011
Poster2 ISRS - Paris 2011Poster2 ISRS - Paris 2011
Poster2 ISRS - Paris 2011
 
5 understanding some basic trial designs in sarcomas (inclusive a placebo one...
5 understanding some basic trial designs in sarcomas (inclusive a placebo one...5 understanding some basic trial designs in sarcomas (inclusive a placebo one...
5 understanding some basic trial designs in sarcomas (inclusive a placebo one...
 
John Luk Shanghai Bioforum 2012-05-11
John Luk Shanghai Bioforum 2012-05-11John Luk Shanghai Bioforum 2012-05-11
John Luk Shanghai Bioforum 2012-05-11
 
Dose Escalation By Imrt And Organ Trackingin Prostate Cancer
Dose Escalation By Imrt And Organ Trackingin Prostate CancerDose Escalation By Imrt And Organ Trackingin Prostate Cancer
Dose Escalation By Imrt And Organ Trackingin Prostate Cancer
 
Quantitative Image Analysis for Cancer Diagnosis and Radiation Therapy
Quantitative Image Analysis for Cancer Diagnosis and Radiation TherapyQuantitative Image Analysis for Cancer Diagnosis and Radiation Therapy
Quantitative Image Analysis for Cancer Diagnosis and Radiation Therapy
 
PIIS0305737223001603.pdf
PIIS0305737223001603.pdfPIIS0305737223001603.pdf
PIIS0305737223001603.pdf
 
Lauro.wcio2011 ny
Lauro.wcio2011 nyLauro.wcio2011 ny
Lauro.wcio2011 ny
 
Transarterial chemoembolization in patients with hepatocellular carcinoma
Transarterial chemoembolization in patients with hepatocellular carcinomaTransarterial chemoembolization in patients with hepatocellular carcinoma
Transarterial chemoembolization in patients with hepatocellular carcinoma
 
12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón
12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón
12 Quimioterapia, 1ª - 2ª línea y mantenimiento. Cáncer de Pulmón
 
Optimizar la protección radiológica del paciente o inferir riesgos de radiaci...
Optimizar la protección radiológica del paciente o inferir riesgos de radiaci...Optimizar la protección radiológica del paciente o inferir riesgos de radiaci...
Optimizar la protección radiológica del paciente o inferir riesgos de radiaci...
 
ACC 2013 what did we learn
ACC 2013 what did we learnACC 2013 what did we learn
ACC 2013 what did we learn
 
1 Hassan
1  Hassan1  Hassan
1 Hassan
 
Module 8 Dr Klotz-LowRiskPC
Module 8 Dr Klotz-LowRiskPCModule 8 Dr Klotz-LowRiskPC
Module 8 Dr Klotz-LowRiskPC
 
Sophie Taieb : Breast MRI in neoadjuvant chemotherapy : A predictive respons...
 Sophie Taieb : Breast MRI in neoadjuvant chemotherapy : A predictive respons... Sophie Taieb : Breast MRI in neoadjuvant chemotherapy : A predictive respons...
Sophie Taieb : Breast MRI in neoadjuvant chemotherapy : A predictive respons...
 
58870-107_Slides.pptx
58870-107_Slides.pptx58870-107_Slides.pptx
58870-107_Slides.pptx
 
Gorlin Group Talk Nov 2012
Gorlin Group Talk Nov 2012Gorlin Group Talk Nov 2012
Gorlin Group Talk Nov 2012
 
NET - Kennecke
NET - KenneckeNET - Kennecke
NET - Kennecke
 
Does CD4 Cell Count Influence CT features of Intracranial Opportunistic Infec...
Does CD4 Cell Count Influence CT features of Intracranial Opportunistic Infec...Does CD4 Cell Count Influence CT features of Intracranial Opportunistic Infec...
Does CD4 Cell Count Influence CT features of Intracranial Opportunistic Infec...
 
Oliva esther aml eurasian st. petersburg 2016
Oliva esther  aml eurasian st. petersburg 2016Oliva esther  aml eurasian st. petersburg 2016
Oliva esther aml eurasian st. petersburg 2016
 

Radiological evaluation aasld 2011

  • 1. AASLD 2011 BLINDED INDEPENDENT CENTRAL RESPONSE ASSESSMENT USING RECIST, MODIFIED RECIST, AND CHOI CRITERIA IN PATIENTS TREATED WITH SORAFENIB FOR ADVANCED HEPATOCELLULAR CARCINOMA Mohamed Bouattour, Johanna Wassermann, Onorina Bruno, Béatrice Larroque, Laurent Castera, Chantal Dreyer, Valérie Vilgrain, Jacques Belghiti, Eric Raymond, Sandrine Faivre Beaujon University Hospital Clichy, France
  • 3. RECIST do Not Capture the True Benefit of Sorafenib in HCC • Sorafenib improves survival but yields low objective response rate by RECIST (< 5%)1,2 • Sustained survival despite NO response by RECIST suggest that RECIST are inappropriate to capture the true benefit of sorafenib3 • Modified RECIST (mRECIST)4 are used to assess vascular effects of TACE5 and CHOI criteria were proposed to evaluate necrosis induced by targeted agents in HCC6 1 LlovetJM ; N Engl J Med 2008 4 Lencioni R ; Semin Liver Dis. 2010 2 Cheng AL ; Lancet Oncol 2009 5 Gillmore R, J Hepatol 2011 3 Edeline J, Cancer 2011 6 Faivre S, Clin Cancer Res 2011 AASLD 2011
  • 4. Objectives • At the first tumor evaluation, are mRECIST and CHOI criteria predicting overall survival in patients with HCC treated with sorafenib? • Can mRECIST and CHOI criteria reallocate to the objective response group, patients who were inappropriately considered non-responders by RECIST? AASLD 2011
  • 5. Study Method/Radiological Evaluation • Retrospective single center cohort analysis • January 2007- December 2009 • Beaujon Hospital • Baseline evaluation within 6 weeks prior to sorafenib • First tumor evaluation by CT-scan 2-3 months after sorafenib initiation AASLD 2011
  • 6. Radiological Evaluation • Quality control criteria – Multiphasic CT-scan fully available for central review – Central Review of data by a radiologist highly experienced in liver cancers, blinded to clinical data – Evaluation of tumor response by RECIST, mRECIST, and CHOI criteria RECIST mRECIST CHOI criteria HU AASLD 2011
  • 7. Results: Study Population Selection Patients with BCLC B-C, Child-Pugh A-B, advanced hepatocellular carcinoma treated with sorafenib from 2007 to 2009 (n=82) Non-evaluable patients (n=22) – Non-evaluable CT scan (n=9) – Target lesions in pretreated area (n=9) – No target lesion (n=3) – Missing data (n=4) • Lost of follow up • Early death Patients evaluated in this study (n=60) AASLD 2011
  • 8. Patient Characteristics Median age, years 61 (37-77) Sex M/F 52/8 Etiology, % (number of patients) Viral 48 (29) Alcohol 23 (14) Child Pugh Score, % (number of patients) A 80 (48) B 20 (12) BCLC stage , % (number of patients) B 33 (20) C 67 (40) Pathological diagnosis, % (number of patients) 88 (53) Extrahepatic Spread , % (number of patients) 35 (21) Prior treatments, % (number of patients) None 32 (19) Surgery 27 (16) Radio Frequency Ablation 5 (3) Trans-Arterial Chemo-Embolization 36 (22) Median duration of sorafenib, months 5.7 Median time for the first evaluation, months 2.1 AASLD 2011
  • 9. mRECIST and CHOI Criteria Identify More Responder Patients Than RECIST Venn diagram of tumor response according to three criteria 15 10 2 RECIST n=2 mRECIST n=12 CHOI criteria n=27 AASLD 2011
  • 10. Response Rates by RECIST, mRECIST, and CHOI Criteria 70 Objective response % of response rates by each criteria 60 Stable Disease 62 Progressive Disease 50 40 48 45 30 35 32 30 20 23 21 10 3 0 RECIST mRECIST CHOI N=60 N=56* AASLD 2011 N=60 *4 pts non evaluable
  • 11. At the first tumor evaluation, are mRECIST and CHOI criteria predicting overall survival in patients with HCC treated with sorafenib? AASLD 2011
  • 12. Responses by RECIST Criteria Correlate with Survival 1 0,9 0,8 RECIST Probability of survival 0,7 0,6 Objective response (PR/CR) 0,5 Stable Disease Progressive Disease 0,4 0,3 0,2 0,1 p=0.0012 0 0 5 10 15 20 25 30 35 40 45 Duration of survival, months
  • 13.
  • 14. Can mRECIST and CHOI criteria reallocate to the objective response group, patients who were inappropriately considered non- responders by RECIST? AASLD 2011
  • 15. Examples of discrepancies Between methods of evaluation RECIST mRECIST CHOI criteria Baseline  Stable  Response  Response ↘ HU Baseline  Progression  Response  Response ↘ HU AASLD 2011
  • 16. Many Stable and Some Progressive Diseases by RECIST Are Objective Responses by mRECIST and CHOI Criteria Objective responses according to each criteria 45% Number of patients with objective response 30 3 25 Response by RECIST Progressive Disease 20 21.4% 15 22 Stable Disease 1 Objective response 10 3.3% 9 5 2 2 2 0 Responders Responders Responders RECIST (n=2) AASLD 2011 (n=27) mRECIST (n=12) CHOI
  • 17. Conclusion • Response rate using mRECIST and CHOI criteria correlates with survival in advanced HCC patients treated with sorafenib • mRECIST and CHOI criteria identify patients with true benefit (partial responders with higher survival) among “RECIST-stable” and “RECIST-progressive” patients • mRECIST and CHOI criteria compared to RECIST increase the number of partial responders who also are patients with a median overall survival >14 months AASLD 2011