Mixed Response Challenge

Efficient Workflows and Reporting compliant with RECIST and Other Quantitative Imaging Standards in Cancer Research and Clinical Practice

Modern targeted therapies play an increasingly important role in the treatment of cancer patients in the era of personalized medicine. Clinical studies already demonstrated considerable tumor response under treatment with new agents such as Sorafenib in HCC and RCC, or Imatinib in GIST. In the face of these modern targeted therapies and increasingly multi-modal therapy approaches, new challenges and opportunities arise for oncological procedures and radiological image-based diagnoses.

A major pitfall in tumor response monitoring is the increasing incidence of mixed response in targeted therapies. A typical example is the treatment with Vemurafenib in metastatic melanoma with specific B-RAF mutation. Response to Vemurafenib is typically not durable because of suddenly developing resistances. An early detection of disease progression provides improved outcome of subsequent therapies, e.g. with the monoclonal antibody Ipilimumab.

A 44-year-old patient with metastatic melanoma treated with Vemurafenib was radiologically assessed according to the RECIST 1.1 guidelines. A first follow-up CT scan eight weeks after treatment start (Baseline) showed mixed response…Read more