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mTOR-inhibitor treatment of metastatic renal cell carcinoma: contribution of Choi and modified Choi criteria assessed in 2D or 3D to evaluate tumor response

  • Oncology
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Abstract

Purpose

To determine whether 2D or 3D Choi and modified Choi (mChoi) criteria could assess the efficacy of everolimus against metastatic renal cell carcinoma (mRCC).

Methods

RECIST-1.1, Choi, and mChoi criteria were applied retrospectively to analyse baseline and 2-month contrast-enhanced computed tomography (CECT) images in 48 patients with mRCC enrolled in the everolimus arm of the French randomized double-blind multicentre phase III trial comparing everolimus versus placebo (RECORD-1). The primary endpoint was centrally reviewed progression-free survival (PFS) calculated from the initial RECORD-1 analysis. Mean attenuation was determined for 2D target lesion regions of interest drawn on CECT sections whose largest diameters had been measured, and for the 3D whole target lesion.

Results

The median PFS was 5.5 months. The median PFS for everolimus responders defined using 3D mChoi criteria was significantly longer than for non-responders (7.6 versus 5.4 months, respectively), corresponding to a hazard ratio for progression of 0.45 (95 % CI: 0.22–0.92), with respective 1-year survival rates of 31 % and 9 %. No other 2D or 3D imaging criteria at 2 months identified patients who would benefit from everolimus.

Conclusions

At 2 months, only 3D mChoi criteria were able to identify mRCC patients with a PFS benefit from everolimus.

Key points

• Choi criteria could not identify everolimus-treated patients with significantly prolonged PFS.

• mCHOI enabled identification of everolimus-treated mRCC patients with a PFS benefit.

• 3D attenuation measurement criteria appeared to perform better than single-slice measurement.

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Abbreviations

mChoi:

Modified Choi

mRCC:

Metastatic renal cell carcinoma

RECIST:

Response Evaluation Criteria in Solid Tumours

CECT:

Contrast-enhanced computed tomography

PFS:

Progression-free survival

GIST:

Gastrointestinal stromal tumour

TKI:

Tyrosine-kinase inhibitor

PR:

Partial response

ROI:

Region of interest

HU:

Hounsfield units

AOI:

Area of interest

VOI:

Volume of interest

HR:

Hazard ratio

CI:

Confidence interval

MASS:

Morphology, attenuation, size and structure criteria

MSKCC:

Memorial Sloan–Kettering Cancer Center

PS:

Performance status

SACT:

Size and attenuation CT measurement

SD:

Standard deviation

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Acknowledgments

The scientific guarantor of this publication is Prof. Olivier Lucidarme. O. Lucidarme declares relationships with the following companies: Boehringer Ingelheim, Roche, Bracco, Novartis, and Pfizer. S. Oudard declares relationships with the following companies: Novartis, Pfizer, Bayer, and Roche. K. Slimane is an employee of Novartis. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Reza Elaidi) has significant statistical expertise. Institutional review board approval was not required because this was a retrospective study, and written informed consent was waived by the institutional review board. Some study subjects or cohorts were previously reported in three papers:

Motzer RJ, Escudier B, Oudard S et al. (2008) Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet 372:449–56

Motzer RJ, Escudier B, Oudard S et al. (2010) Phase 3 trial of everolimus for metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer 116:4256–65

Oudard S, Thiam R, Fournier LS et al. (2012) Optimisation of the tumour response threshold in patients treated with everolimus for metastatic renal cell carcinoma: analysis of response and progression-free survival in the RECORD-1 study. Eur J Cancer 48:1512–8

Methodology: retrospective, multicenter study.

Author information

Authors and Affiliations

  1. Oncology Unit, Georges-Pompidou Hospital, APHP, Paris, France

    R. Elaidi & S. Oudard

  2. Service de Radiologie Polyvalente et Oncologique, Groupe Hospitalier Pitié–Salpêtrière, APHP UPMC, 47–83, Bd de l’Hôpital, 75651, Paris Cedex 13, France

    S. Raslan, R. Renard Penna, M. Wagner & O. Lucidarme

  3. Sorbonne Universités, UPMC Univ Paris 06, INSERM, CNRS, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, France

    M. Lamuraglia & O. Lucidarme

  4. Medical Oncology Department, Gustave-Roussy Institute, Villejuif, France

    B. Escudier

  5. Novartis Pharma, Rueil-Malmaison, France

    K. Slimane

Authors
  1. M. Lamuraglia
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  2. S. Raslan
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  3. R. Elaidi
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  4. S. Oudard
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  5. B. Escudier
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  6. K. Slimane
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  7. R. Renard Penna
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  8. M. Wagner
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  9. O. Lucidarme
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Correspondence to O. Lucidarme.

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Lamuraglia, M., Raslan, S., Elaidi, R. et al. mTOR-inhibitor treatment of metastatic renal cell carcinoma: contribution of Choi and modified Choi criteria assessed in 2D or 3D to evaluate tumor response. Eur Radiol 26, 278–285 (2016). https://doi.org/10.1007/s00330-015-3828-7

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  • DOI: https://doi.org/10.1007/s00330-015-3828-7

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