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The Effect of Intrathoracic Lesion Location on Initial Tyrosine Kinase Inhibitor Response in Advanced Oncogene-Addicted Non-Small Cell Lung Cancer: A Comparison Between RECIST 1.1 and a Novel Method of Response Assessment (MAX)

  • Author Footnotes
    # These authors contributed equally to the manuscript.
    Tami J. Bang
    Footnotes
    # These authors contributed equally to the manuscript.
    Affiliations
    Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, CO
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  • Author Footnotes
    # These authors contributed equally to the manuscript.
    Junxiao Hu
    Footnotes
    # These authors contributed equally to the manuscript.
    Affiliations
    Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO; University of Colorado Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO
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  • Tejas Patil
    Affiliations
    Division of Medical Oncology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
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  • Anna E. Barón
    Affiliations
    Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO,
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  • Dexiang Gao
    Affiliations
    Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, CO; University of Colorado Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO
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  • James Chih-Hsin Yang
    Affiliations
    Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
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  • Hung-Yang Kuo
    Affiliations
    Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
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  • Hsin-Chieh Huang
    Affiliations
    Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan
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  • Peter B. Sachs
    Affiliations
    Division of Cardiothoracic Imaging, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, CO
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  • D. Ross Camidge
    Correspondence
    Address for correspondence: D. Ross Camidge, MS, Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, 1665 North Aurora Court, Aurora, CO 80045, USA. Tel.: +1 720 848 0449.
    Affiliations
    Division of Medical Oncology, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
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  • Author Footnotes
    # These authors contributed equally to the manuscript.
Published:August 06, 2022DOI:https://doi.org/10.1016/j.cllc.2022.08.004

      Abstract

      Introduction

      Different subtypes of non-small cell lung cancer (NSCLC) are associated with different patterns of metastatic spread. Anatomic location of lesions in the chest may influence patterns of cancer growth and the shrinkage to therapy. Consequently, lesion location could affect apparent response rates per RECIST. We sought to explore this and develop, as needed, treatment response assessments less affected by the location.

      Methods

      Cases of advanced oncogene-addicted NSCLC (EGFR, ALK, and ROS1) with pre- and on-therapy imaging during initial targeted therapy were identified. Lesions located in the lung parenchyma, pleural space or intra-thoracic lymph nodes were identified and analyzed separately from each other by RECIST 1.1 (unidimensional measurements) and by a novel MAX methodology (bidimensional measurements) which takes the axis with the greatest absolute percentage change on therapy in each location as the representative measurement.

      Results

      Three hundred three patients with 446 unidimensional measured lesions were included for RECIST analysis. Two hundred forty nine patients with 386 bidimensional measured lesions were included for MAX analysis, as well as the analysis comparing RECIST and MAX. Intrathoracic location significantly impacted percentage shrinkage and the response rate per RECIST. The response rates for pleural, intra-parenchymal and nodal lesions were 34.1%, 49.6%, and 68.3%, respectively (P = .0002). The MAX methodology both increased the apparent treatment effect and made it consistent between intrathoracic locations. For pleural, parenchymal and nodal lesions, the MAX calculated response rate were 83.7%, 72.2%, and 75.4%, respectively (P-value = .24).

      Conclusion

      Intrathoracic lesion location affects RECIST-based treatment effectiveness estimations. The MAX methodology neutralizes location effect when examining impact of treatment and should be explored further.

      Keywords

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