title: Alternative Response Criteria (Choi, European association for the study of the liver, and modified Response Evaluation Criteria in Solid Tumors [RECIST]) Versus RECIST 1.1 in patients with advanced hepatocellular carcinoma treated with sorafenib.
abstract: BACKGROUND
  Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1), may underestimate activity and does not predict survival in patients with hepatocellular carcinoma (HCC) treated with sorafenib. This study assessed the value of alternative radiological criteria to evaluate response in HCC patients treated with sorafenib.
  
  
  METHODS
  A retrospective blinded central analysis was performed of computed tomography (CT) scans from baseline and the first tumor evaluation in consecutive patients treated with sorafenib over a 2-year period in a single institution. Four different evaluation criteria were used: Choi, European Association for the Study of the Liver (EASL), modified RECIST (mRECIST), and RECIST 1.1.
  
  
  RESULTS
  Among 82 HCC patients, 64 with Barcelona Clinic Liver Cancer stage B-C were evaluable with a median follow-up of 22 months. Median duration of sorafenib treatment was 5.7 months, and median overall survival was 12.8 months. At the time of the first CT scan, performed after a median of 2.1 months, Choi, EASL, mRECIST, and RECIST 1.1 identified 51%, 28%, 28%, and 3% objective responses, respectively. Responders by all criteria showed consistent overall survival >20 months. Among patients with stable disease according to RECIST 1.1, those identified as responders by Choi had significantly better overall survival than Choi nonresponders (22.4 vs. 10.6 months; hazard ratio: 0.43, 95% confidence interval: 0.15-0.86, p = .0097).
  
  
  CONCLUSIONS
  Choi, EASL, and mRECIST criteria appear more appropriate than RECIST 1.1 to identify responders with long survival among advanced HCC patients benefiting from sorafenib.
authors.affiliation: Departments of Radiology, Hepatology, Medical Oncology, Biostatistics, and Hepatobiliary and Pancreatic Surgery, Beaujon University Hospital, Assistance Publique Hopitaux de Paris, Clichy, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Ronot
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bouattour
authors.forename: Johanna
authors.initials: J
authors.lastname: Wassermann
authors.forename: Onorina
authors.initials: O
authors.lastname: Bruno
authors.forename: Chantal
authors.initials: C
authors.lastname: Dreyer
authors.forename: Béatrice
authors.initials: B
authors.lastname: Larroque
authors.forename: Laurent
authors.initials: L
authors.lastname: Castera
authors.forename: Valérie
authors.initials: V
authors.lastname: Vilgrain
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Eric
authors.initials: E
authors.lastname: Raymond
authors.forename: Sandrine
authors.initials: S
authors.lastname: Faivre
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D066066:Response Evaluation Criteria in Solid Tumors; D012189:Retrospective Studies; D000077157:Sorafenib; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D009536:Niacinamide; D000077157:Sorafenib
keywords: Antiangiogenic agents; Computed tomography; Density; Targeted therapy; Tumor evaluation