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Nat Clin Pract Oncol
2008[Nov]; 5
(11
): 634-44
PMID18711427
show ga
The current method for assessing the response to therapy of glial tumors was
described by Macdonald et al. in 1990. Under this paradigm, response
categorization is determined on the basis of changes in the cross-sectional area
of a tumor on neuroimaging, coupled with clinical assessment of neurological
status and corticosteroid utilization. These categories of response have certain
limitations; for example, cross-sectional assessment is not as accurate as
volumetric assessment, which is now feasible. Disentangling antitumor effects of
therapies from their effects on blood-brain barrier permeability can be
challenging. The use of insufficient response criteria might be overestimating
the true benefits of drugs in early-stage studies, and, therefore, such therapies
could mistakenly move forward into later phases, only to result in disappointment
when overall survival is measured. We propose that studies report both
radiographic and clinical response rates, use volumetric rather than
cross-sectional area to measure lesion size, and incorporate findings from
mechanistic imaging and blood biomarker studies more frequently, and also suggest
that investigators recognize the limitations of imaging biomarkers as surrogate
end points.
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