Comparison of modified Response Evaluation Criteria in Solid Tumors, European Organization for Research and Treatment of Cancer criteria, and PET Response Criteria in Solid Tumors for evaluation of tumor response to chemotherapy and prognosis prediction in patients with unresectable malignant pleural mesothelioma

Our plain-English summary of Comparison of modified Response Evaluation Criteria in Solid Tumors, European Organization for Research and Treatment of Cancer criteria, and PET Response Criteria in Solid Tumors for evaluation of tumor response to chemotherapy and prognosis prediction in patients with unresectable malignant pleural mesothelioma, by K. Kitajima, M. Maruyama, T. Minami, et al (Nuclear Medicine Communications, 2020).

The study

• Authors: K. Kitajima, M. Maruyama, T. Minami, T. Yokoi, K. Kuribayashi, T. Kijima, M. Hashimoto, S. Hasegawa, K. Yamakado
• Journal: Nuclear Medicine Communications
• Published: 2020;41(8):790-799
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To compare modified RECIST (mRECIST), EORTC criteria, and PERCIST for response evaluation and prognosis prediction in advanced malignant pleural mesothelioma (MPM) patients treated with chemotherapy.

Methods: Patients with MPM and not curative surgery candidates (n = 75) underwent standard chemotherapy with cisplatin and pemetrexed. CT and [F]fluorodeoxyglucose PET/CT scans were performed at baseline and after three chemotherapy cycles. Chemotherapeutic response was evaluated according to mRECIST, EORTC, and PERCIST, then concordance among those was assessed using Cohen's κ coefficient. PFS and OS were examined using log-rank and Cox methods.

Results: With EORTC, 27 patients had PMD, 23 SMD, 17 PMR, and eight CMR, while with PERCIST those were 28, 22, 11, and 14, respectively. Using mRECIST, 28 had PD, 29 SD, 18 PR, and 0 CR. Although there was high concordance between EORTC and PERCIST (82.7% of patients; κ = 0.83), that between mRECIST and EORTC (38.7%; κ = 0.27) and mRECIST and PERCIST (36.0%; κ = 0.26) was low. According to both EORTC and PERCIST, patients with no progression (CMR/PMR/SMD) showed significantly longer PFS and OS than PMD patients (EORTC: P = 0.0024 and P = 0.039, respectively, PERCIST: P = 0.0012 and P = 0.024, respectively), while according to mRECIST, those who achieved no progression (PR/SD) showed significantly longer PFS than PD patients (P = 0.011), but not significantly longer OS (P = 0.11).

Conclusion: EORTC and PERCIST are more accurate than mRECIST for evaluation of tumor response to chemotherapy and predicting prognosis in unresectable MPM patients.

In plain English

This retrospective study from a single hospital in Japan (Hyogo College of Medicine) looked at 75 patients with malignant pleural mesothelioma who could not have surgery and who received pemetrexed with cisplatin or carboplatin. It compared three ways of judging whether tumors responded after three cycles of chemotherapy. mRECIST measures tumor thickness on CT scans. The EORTC criteria and PERCIST measure how much sugar tracer the tumor takes up on FDG-PET/CT scans. The two PET-based methods gave the same classification for 82.7% of patients. mRECIST matched EORTC for only 38.7% of patients and matched PERCIST for only 36.0%. Under all three methods, patients whose disease did not progress had significantly longer progression-free survival. For overall survival, the difference was statistically significant with EORTC (P = 0.039) and PERCIST (P = 0.024) but not with mRECIST (P = 0.11). The authors concluded that EORTC and PERCIST were more accurate than mRECIST for judging response and predicting outcome in these patients. They noted the study was retrospective, single-center and small. The study did not examine asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-center study comparing three tumor-response criteria (mRECIST on CT, EORTC criteria and PERCIST on FDG-PET/CT)
• Who was studied: 75 patients with malignant pleural mesothelioma who were not candidates for surgery. They came from 114 patients referred to the authors' institution in Japan between May 2009 and December 2018; those who had previously had talc pleurodesis were excluded. Mean age was 66.8 years (range 46 to 79); 64 were male and 11 female.
• Exposure: First-line chemotherapy with pemetrexed plus cisplatin, or pemetrexed plus carboplatin. Response was assessed on contrast-enhanced CT and FDG-PET/CT at baseline and after three cycles. Asbestos exposure was not assessed in this study; it is mentioned only in the introduction as the main cause of the disease.
• Main results:
  • By mRECIST (CT), progressive disease was found in 28 patients (37.3%), stable disease in 29 (38.7%), partial response in 18 (24.0%), and complete response in 0.
  • By EORTC criteria (PET), progressive metabolic disease was found in 27 patients (36.0%), stable metabolic disease in 23 (30.7%), partial metabolic response in 17 (22.7%), and complete metabolic response in 8 (10.7%).
  • By PERCIST (PET), the same four categories (progressive, stable, partial response, complete response) contained 28 (37.3%), 22 (29.3%), 11 (14.7%) and 14 (18.7%) patients, respectively.
  • Agreement between EORTC and PERCIST was high: 82.7% of patients, kappa 0.83.
  • Agreement of mRECIST with the PET-based methods was low: with EORTC, 38.7% of patients (kappa 0.27); with PERCIST, 36.0% (kappa 0.26).
  • Disease progressed in 73 of the 75 patients after a median of 7.7 months.
  • 71 of the 75 patients died from malignant pleural mesothelioma after a median of 17.8 months.
  • Under all three methods, patients without progression had significantly longer progression-free survival than patients with progression (P = 0.011 for mRECIST, P = 0.0024 for EORTC, P = 0.0012 for PERCIST).
  • Patients with a metabolic response (complete or partial) had significantly longer progression-free survival than those without, by EORTC (P = 0.0030) and by PERCIST (P = 0.0010).
  • By EORTC and PERCIST, patients without progression had significantly longer overall survival than patients with progressive metabolic disease (P = 0.039 for EORTC, P = 0.024 for PERCIST).
  • By mRECIST, overall survival was not significantly longer for patients without progression than for those with progressive disease (P = 0.11).
  • Compared with EORTC, PERCIST showed slightly greater accuracy for predicting prognosis, but the difference was not statistically significant.
• The authors' conclusion: The authors concluded that both the EORTC criteria and PERCIST on FDG-PET/CT were more accurate than mRECIST on contrast-enhanced CT for evaluating tumor response to chemotherapy and predicting prognosis in patients with unresectable malignant pleural mesothelioma.
• Limitations the authors state:
  • The study was retrospective, at a single center, with a small sample size, so the findings may not generalize and statistical errors are possible.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Modified RECIST (mRECIST), Chemotherapy, Prognosis, Unresectable, Pleural Mesothelioma, Cisplatin, Pemetrexed (Alimta), CT Scan.

Related studies

• Revised Modified Response Evaluation Criteria in Solid Tumors for Assessment of Response in Malignant Pleural Mesothelioma (Version 1.1) — S.G. Armato, A.K. Nowak (2018)
• Metabolic response assessment with 18F-FDG-PET/CT is superior to modified RECIST for the evaluation of response to platinum-based doublet chemotherapy in malignant pleural mesothelioma — S. Kanemura, K. Kuribayashi, et al. (2017)
• Epirubicin in malignant mesothelioma: a phase II study of the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group — K. Mattson, G. Giaccone, et al. (1992)
• Volumetric PET Response Assessment Outperforms Conventional Criteria in Patients Receiving High-Dose Pembrolizumab for Malignant Mesothelioma — J. Ferdinandus, F. Barbato, et al. (2021)
• Progression free survival rate at 9 and 18 weeks predict overall survival in patients with malignant pleural mesothelioma: an individual patient pooled analysis of 10 European Organisation for Research and Treatment of Cancer Lung Cancer Group studies and an independent study validation — B. Hasan, L. Greillier, et al. (2014)
• Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma — K. Kitajima, H. Doi, et al. (2017)

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