Radiology & Novel Cancer Therapies

Biography

Biography: Richard M Gore

Abstract

Introduction: Traditional chemotherapy is cytotoxic in nature and acts primarily by eliminating neoplastic cells. Change in tumor size, which is an indicator of change in the number of neoplastic cells, evolved into the radiologic biomarker of treatment response. Over the last decade, dramatic advances in understanding the genetics and molecular biology of tumors have revolutionized therapy for many neoplasms. Molecular targeted therapy and immunotherapy have led to new, individualized tumor therapies. These interfere with signaling pathways and thereby inhibit cell grown but do not necessarily lead to cell death, unlike cytotoxic drugs. With targeted agents, lack of progression may be associated with positive improvement in outcome, even in the absence of major shrinkage of tumors. Oncologists have become interested in the length of time that cancer does not grow or metastasize. Progression-free survival has become the preferred endpoint for many cancer therapy trials. In this presentation, new criteria for imaging tumor response in the era of personalized medicine are presented and guidelines for learning when it is appropriate to resist using RECIST are presented.

Conventional anatomic criteria:

WHO

RECIST

RECIST 1.1

Functional criteria:

Choi

Modified Choi

MAST

EASL

mRECIST

RECICL

irRC

SACT 

Metabolic criteria:

PERSIST

PET-CT

PET-MR

Evolving imaging biomarkers:

Perfusion

DWI

MRE

MRS

Volumetry

Growth kinetics

Conclusion: RECIST 1.1 is the mainstay of evaluating tumor response to therapy for most cancers

These criteria depend primarily on assessing changes in tumor dimensions but they do not reflect other morphologic, functional, or metabolic changes that may occur with novel chemotherapy, targeted or immunotherapy. It is important for radiologists to integrate new concepts in the evaluation of tumor response in