Adrenocortical Carcinoma and CT Assessment of Therapy Response: The Value of Combining Multiple Criteria

Abstract

We evaluated tumor response at Computed Tomography (CT) according to three radiologic criteria: RECIST 1.1, CHOI and tumor volume in 34 patients with metastatic adrenocortical carcinoma (ACC) submitted to standard chemotherapy. These three criteria agreed in defining partial response, stable or progressive disease in 24 patients (70.5%). Partial response (PR) was observed in 29.4%, 29.4% and 41.2% of patients according to RECIST 1.1, CHOI and tumor volume, respectively. It was associated with a favorable prognosis, regardless of the criterion adopted. The concordance of all the 3 criteria in defining the disease response identified 8 patients (23.5%) which displayed a very good prognosis: median progression free survival (PFS) and overall survival (OS) 14.9 and 37.7 months, respectively. Seven patients (20.6%) with PR assessed by one or two criteria, however, still had a better prognosis than non-responding patients, both in terms of PFS: median 12.3 versus 9.9 months and OS: 21 versus 12.2, respectively. In conclusions, the CT assessment of disease response of ACC patients to chemotherapy with 3 different criteria is feasible and allows the identification of a patient subset with a more favorable outcome. PR with at least one criterion can be useful to early identify patients that deserve continuing the therapy.

Phase II study of cabazitaxel as second-third line treatment in patients with metastatic adrenocortical carcinoma

“…Noteworthy, when the activity was assessed according to Choi criteria, disease response was observed in 55% of patients; this is consistent with a previous experience suggesting a possible role of these criteria, usually used to evaluate the activity of molecular target agents, 37 , 38 in the assessment of response to chemotherapy in ACC patients. 29 The assessment of response according to Choi, however, was a secondary endpoint of this study, so these results should be considered hypothesis generating. The association of the Choi response with improved disease-free survival supports the rationale of testing these criteria in future studies.…”

“…Disease response was assessed according to RECIST 1.1 and Choi criteria as described in the preceding text. 29 …”

Eighth International Adrenal Cancer Symposium Brescia, Italy, September 30 to October 1–2, 2021

“…Progression free survival (PFS) is currently the most used surrogate endpoints in ACC, although not validated yet. The radiologically assessed response according to RECIST criteria is a useful measure of treatment activity but there is uncertainty regarding its use as a surrogate efficacy parameter [8]. New endpoints are needed to better take into account the challenges offered by different clinical situations and treatment strategies.…”

Adrenocortical Carcinoma

“…A clinical paper published in this Special Issue shows that the assessment of disease response to chemotherapy might be improved by concomitant evaluation of three different criteria, i.e., RECIST, Choi, and volumetric. The results show that the disease response, concordantly assessed by all three criteria, allows for the identification of a patient subset with a more favorable outcome [ 23 ]. ACC frequently recurs in the peritoneum after primary surgical resection.…”