Imaging endpoints for clinical trial use: a RECIST perspective

Effectiveness and safety of ICIs for the treatment of advanced CC: a systematic review and meta-analysis

Background

The use of immune checkpoint inhibitors has recently become a promising and innovative therapeutic option for patients suffering from advanced recurrent or metastatic cervical cancer(CC), and several studies of immunotherapy have been published or have revealed stage-by-stage results at international congresses. Nevertheless, there is a lack of meta-analyses of ICIs for advanced CC in past Meta-analysis.

Method

This meta-analysis rigorously followed the PRISMA guidelines, using Review Manager V.5.4 and R(v4.2.2) software for data synthesis. Hazard ratios, risk ratios, and risk differences were calculated, with statistical significance assessed via the Mantel-Haenszel test. Heterogeneity was evaluated using the Higgins I2 statistic, and sensitivity analyses were conducted if heterogeneity surpassed 50%. The efficacy outcomes examined and gathered included the overall response rate (ORR), progress-free survival, overall survival(OS), and the adverse events (AEs), crucial for understanding the efficacy and safety of ICIs in advanced cervical cancer.

Result

The results demonstrate significant efficacy and manageable safety of ICIs in advanced cervical cancer. In RCTs, ICIs improved OS (HR = 0.66, 95% CI: 0.58-0.75, P < 0.00001) and PFS (HR = 0.67, 95% CI: 0.59-0.75, P < 0.0001), with a 34% and 33% reduction in death and progression risks, respectively. ORR was higher in ICIs groups (RR = 1.39, 95% CI: 1.08-1.80, P = 0.01). Single-arm studies supported these findings (ORR: RD = 0.31, 95% CI: 0.22-0.40, P < 0.0001). Safety profiles were manageable, with comparable TRAEs in RCTs and higher incidences in single-arm studies. Subgroup analysis revealed superior OS benefits in PD-L1-positive patients (CPS ≥1, HR = 0.65, 95% CI: 0.50-0.84, P = 0.001) and significant efficacy in squamous cell carcinoma (HR = 0.67, P < 0.00001). Sensitivity analysis confirmed robust OS results (I² = 0%) and stable ORR despite heterogeneity. Risk of bias was low to moderate.

Conclusion

Our meta-analysis reveals that immune checkpoint inhibitors (ICIs) significantly prolong overall survival in advanced cervical cancer patients, reducing the hazard ratio for death. Despite heterogeneity in outcomes, ICIs offer substantial treatment benefits. Further research is needed to optimize usage and monitor AEs.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023387789.

Utility of interim apparent diffusion coefficient value in predicting treatment response among patients with locally advanced cervical cancer treated with radiotherapy

Background

For locally advanced cervical cancer (LACC), treatment response to radiotherapy (RT) can vary significantly even among those with the same stage classification of International Federation of Gynecology and Obstetrics (FIGO). This study investigated the value of ADC metric for forecasting end-of-treatment outcomes in LACC patients referred for RT.

Methods

Eighty patients with pathologically confirmed cervical squamous cell carcinoma with (SCC) were included in the research. Abdominal or pelvic MRI scans were conducted at least three times for all participants: before RT, three weeks after beginning of RT and approximately two months after RT was finalized. Calculated apparent diffusion coefficient (ADC) values of the LACC include: pre-ADC, interim-ADC, ΔADC and Δ%ADC. Based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, subjects were calculated and subsequently categorized into good responders group (complete response) and poor responders group (progressive disease, stable disease or partial response).

Results

Compared to good-responders, subjects of poor-responder group showed significantly lower values of interim-ADC, ΔADC, and Δ%ADC (all P < 0.05). To distinguish between good and poor responders, the optimal cutoff values of interim-ADC, ΔADC, and Δ%ADC were determined to be 1.067 × 10-3 mm2/sec, 0.209 × 10-3 mm2/sec, and 30.74 % using the ROC curve, with corresponding sensitivities of 83.78 %, 86.49 %, 75.68 %, and specificities of 88.37 %, 86.49 %, 75.68 %, respectively. Multivariate logistic regression revealed that the baseline tumor diameter and interim-ADC were significant prognostic factors for treatment response with an odds ratio (OR) of 0.105 (95 % confidence interval [95 % CI] 0.018-0.616) for baseline tumor diameter and 42.896 (95 % CI 8.205-224.262) for interim-ADC.

Conclusion

The interim-ADC value and baseline tumor diameter surfaced as possible indicative factors for predicting the response to RT in patients with LACC.

How Does Target Lesion Selection Affect RECIST? A Computer Simulation Study

OBJECTIVES

Response Evaluation Criteria in Solid Tumors (RECIST) is grounded on the assumption that target lesion selection is objective and representative of the change in total tumor burden (TTB) during therapy. A computer simulation model was designed to challenge this assumption, focusing on a particular aspect of subjectivity: target lesion selection.

MATERIALS AND METHODS

Disagreement among readers and the disagreement between individual reader measurements and TTB were analyzed as a function of the total number of lesions, affected organs, and lesion growth.

RESULTS

Disagreement rises when the number of lesions increases, when lesions are concentrated on a few organs, and when lesion growth borders the thresholds of progressive disease and partial response. There is an intrinsic methodological error in the estimation of TTB via RECIST 1.1, which depends on the number of lesions and their distributions. For example, for a fixed number of lesions at 5 and 15, distributed over a maximum of 4 organs, the error rates are observed to be 7.8% and 17.3%, respectively.

CONCLUSIONS

Our results demonstrate that RECIST can deliver an accurate estimate of TTB in localized disease, but fails in cases of distal metastases and multiple organ involvement. This is worsened by the "selection of the largest lesions," which introduces a bias that makes it hardly possible to perform an accurate estimate of the TTB. Including more (if not all) lesions in the quantitative analysis of tumor burden is desirable.

Imaging-guided prognostic score-based approach to assess the benefits of combotherapy versus monotherapy with immune checkpoint inhibitors in metastatic MSI-H colorectal cancer patients

BACKGROUND

This retrospective study determined survival responses to immune checkpoint inhibitors (ICIs), comparing mono- (mono) and combo-immunotherapy (combo) in patients with microsatellite instability-high (MSI-H) metastatic colorectal cancer (mCRC) by analyzing quantitative imaging data and clinical factors.

METHODS

One hundred fifty patients were included from two centers and divided into training (n = 105) and validation (n = 45) cohorts. Radiologists manually annotated chest-abdomen-pelvis computed tomography and calculated tumor burden. Progression-free survival (PFS) was assessed, and variables were selected through Recursive Feature Elimination. Cutoff values were determined using maximally selected rank statistics to binarize features, forming a risk score with hazard ratio-derived weights.

RESULTS

In total, 2258 lesions were annotated with excellent reproducibility. Key variables in the training cohort included: total tumor volume (cutoff: 73 cm3), lesion count (cutoff: 20), age (cutoff: 60) and the presence of peritoneal carcinomatosis. Their respective weights were 1.13, 0.96, 0.91, and 0.38, resulting in a risk score cutoff of 1.36. Low-score patients showed similar overall survival and PFS regardless of treatment, while those with a high-score had significantly worse survivals with mono vs combo (P = 0.004 and P = 0.0001). In the validation set, low-score patients exhibited no significant difference in overall survival and PFS with mono or combo. However, patients with a high-score had worse PFS with mono (P = 0.046).

CONCLUSIONS

A score based on total tumor volume, lesion count, the presence of peritoneal carcinomatosis, and age can guide MSI-H mCRC treatment decisions, allowing oncologists to identify suitable candidates for mono and combo ICI therapies.