Early evaluation of sunitinib for the treatment of advanced gastroenteropancreatic neuroendocrine neoplasms via CT imaging: RECIST 1.1 or Choi Criteria?

Yanji Luo,Ling Xu,Zi-Ping Li,Jie Chen,Yuan Lin,Kun Huang,Minhu Chen,Shi-Ting Feng

doi:10.1186/s12885-017-3150-7

Abstract

BackgroundThe aim of this study was to assess and compare the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) and the Choi criteria in evaluating the early response of advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) treated with sunitinib.MethodsEighteen patients with pathologically proven advanced GEP-NENs treated with sunitinib were enrolled in the study. Pre- and post-treatment CT scans (plain, biphasic enhanced CT scan) were performed on all patients. Changes in the target tumor size and density from pre-treatment to 1.4–3.1 months after treatment were measured and recorded for each patient. Tumor responses were identified using RECIST 1.1 and Choi criteria. The time to tumor progression (TTP) for each patient was measured and compared between groups using the Kaplan-Meier method.ResultsAmong the 18 patients, 4 (22%) exhibited a partial response (PR), 9 (50%) exhibited stable disease (SD), and 5 (28%) experienced progressive disease (PD), using RECIST 1.1. However, based on the Choi criteria, 8 (44%) patients exhibited a PR, 4 (22%) exhibited SD, and 6 (33%) experienced PD. According to RECIST 1.1, the median TTP of PR, SD and PD group were 16.6, 10.8 and 2.3 months, respectively. The TTP of the PR group was significantly longer than that of the PD group (P = 0.007) but insignificant when compared to the SD group (P = 0.131). According to Choi criteria, the median TTP of PR, SD and PD group were not reached, 10.8 and 2.3 months, respectively. The TTP of the PR group was significantly longer than that of the SD (P = 0.026) and PD groups (P < 0.001).ConclusionThe Choi criteria appear to be more sensitive and more precise than RECIST 1.1 in assessing the early response of advanced GEP-NENs treated with sunitinib.

Highlights

The aim of this study was to assess and compare the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) and the Choi criteria in evaluating the early response of advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-Neuroendocrine neoplasms (NENs)) treated with sunitinib
Neuroendocrine neoplasms (NENs) comprise a wide range of malignancies originating from the neuroendocrine cells throughout the human body that constitute the endocrine system, or they may be derived from the diffuse neuroendocrine system [1]
Tumor response assessment according to RECIST version 1.1 and the Choi criteria Using the parameters mentioned above, we evaluated each individual’s responses and grouped them as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD) according to RECIST version 1.1 and the Choi criteria [20, 24] (Table 1)

Summary

Introduction

The aim of this study was to assess and compare the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) and the Choi criteria in evaluating the early response of advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) treated with sunitinib. Gastroenteropancreatic (GEP)-NENs are the most common type of NENs, accounting for 67.5% of all NEN cases [3]. These tumors are categorized as functional or nonfunctional based on the presence of hormone production, biological effects, and symptoms. Well-differentiated GEP-NENs are considered to be neuroendocrine tumors and are graded as G1 (mitotic count 20 per 10 HPFs and/or Ki67 > 20%) or mixed adenoneuroendocrine carcinomas [4]

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