Pantaleo M A, Nannini M, Lopci E, Castellucci P, Maleddu A, Lodi F, Nanni C, Allegri V, Astorino M, Brandi G, Di Battista M, Boschi S, Fanti S, Biasco G
University of Bologna, Institute of Hematology and Medical Oncology 'L&A Seragnoli', Sant'Orsola-Malpighi Hospital, I-40138 Bologna, Italy.
Int J Oncol. 2008 Sep;33(3):443-52.
The widespread use of several new non-cytotoxic drugs and the significant improvements in functional imaging highlights a number of difficulties in monitoring, interpreting and predicting treatment response in clinical practice. Certain guidelines for disease assessment after therapy are already available: the traditional Response Evaluation Criteria in Solid Tumours guidelines based on tumour size variations using conventional imaging technologies, the recent combined method developed by Choi and colleagues in gastrointestinal stromal tumour treated with tyrosine kinase inhibitors based on tumour density variations using computed tomography (CT), and the European Organization for Research and Treatment of Cancer criteria based on tumour glucose metabolism variations using fluorodeoxyglucose (FDG) positron emission tomography (PET). At the moment combined PET/CT response criteria are still not available. A number of new PET compounds other than FDG are also currently being developed to visualize specific cellular and molecular tumour pathways but their role in assessment and prediction of cancer treatment response has not yet been thoroughly investigated in a large series. However, in clinical practice many oncologists treat cancer patients with targeted therapies or chemotherapy and evaluate the response using conventional or functional imaging without appropriate and standardized guidelines. The aim of this study was to present a selection of clinical cases that illustrate the usefulness of new PET tracers and efficacy evaluation of new drugs. In the era of molecular imaging and molecular therapies, these cases highlight the urgency to develop new criteria for treatment assessment and the exigency of correctly interpreting the biological information obtained from new technologies, and introduce new concepts that require further investigation in clinical trials.
几种新型非细胞毒性药物的广泛应用以及功能成像的显著进步凸显了临床实践中在监测、解读和预测治疗反应方面的诸多困难。目前已有一些治疗后疾病评估的指南：基于传统成像技术测量肿瘤大小变化的传统实体瘤疗效评价标准；最近Choi及其同事针对接受酪氨酸激酶抑制剂治疗的胃肠道间质瘤开发的基于计算机断层扫描（CT）测量肿瘤密度变化的联合方法；以及基于氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）测量肿瘤葡萄糖代谢变化的欧洲癌症研究与治疗组织标准。目前PET/CT联合反应标准仍未出台。除FDG外，目前也正在研发多种新型PET化合物以可视化特定的肿瘤细胞和分子通路，但它们在癌症治疗反应评估和预测中的作用尚未在大量研究中得到充分探究。然而，在临床实践中，许多肿瘤学家在使用靶向治疗或化疗治疗癌症患者时，在没有适当和标准化指南的情况下，使用传统或功能成像来评估反应。本研究的目的是展示一系列临床病例，以说明新型PET示踪剂的实用性和新药的疗效评估。在分子成像和分子治疗的时代，这些病例凸显了制定新的治疗评估标准的紧迫性以及正确解读从新技术获得的生物学信息的迫切性，并引入了需要在临床试验中进一步研究的新概念。
