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Open AccessArticle

Correlation of RECIST, Computed Tomography Morphological Response, and Pathological Regression in Hepatic Metastasis Secondary to Colorectal Cancer: The AVAMET Study

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Medical Oncology Department, Complejo Hospitalario de Navarra, Instituto de investigaciones Sanitarias de Navarra (IdISNA), 31008 Pamplona, Spain
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Pathology Department, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
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Radiology Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
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General and digestive surgery Department, Hospital Universitario Josep Trueta, 17007 Girona, Spain
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Medical Oncology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
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Medical Oncology Department, Hospital Universitario La Paz, 28046 Madrid, Spain
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Medical Oncology Department, Hospital Universitario Donostia, 20014 San Sebastian, Spain
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Medical Oncology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain
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Medical Oncology Department, Hospital General Universitario de Valencia, 46014 Valencia, Spain
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Medical Oncology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
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Medical Oncology Department, Hospital Arnau de Vilanova, 46015 Valencia, Spain
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Medical Oncology Department, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain
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Medical Oncology Department, Hospital la Santa Creu i Sant Pau, 08041 Barcelona, Spain
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Medical Oncology Department, Hospital de Mar, 08003 Barcelona, Spain
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Medical Oncology Department, C.S. Parc Taulí, 08208 Sabadell, Spain
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Medical Oncology Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
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Medical Oncology Department, Hospital Universitario Son Llàtzer, 07198 Palma de Mallorca, Spain
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Medical Oncology Department, Hospital Xeral Cíes, 36204 Vigo, Spain
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Medical Oncology Department, Hospital Clínico Universitario de la Arrixaca, 30120 Murcia, Spain
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Medical Oncology Department, Complejo Hospitalario de Ourense, 32005 Ourense, Spain
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Author to whom correspondence should be addressed.
Cancers 2020, 12(8), 2259; https://doi.org/10.3390/cancers12082259
Received: 8 July 2020 / Revised: 2 August 2020 / Accepted: 8 August 2020 / Published: 12 August 2020
(This article belongs to the Special Issue Metastatic Colorectal Cancer)
Background: The prospective phase IV AVAMET study was undertaken to correlate response evaluation criteria in solid tumors (RECIST)-defined response rates with computed tomography-based morphological criteria (CTMC) and pathological response after liver resection of colorectal cancer metastases. Methods: Eligible patients were aged ≥18 years, with Eastern Cooperative Oncology Group (ECOG) performance status 0/1 and histologically-confirmed colon or rectal adenocarcinoma with measurable liver metastases. Preoperative treatment was bevacizumab (7.5 mg on day 1) + XELOX (oxaliplatin 130 mg/m2, capecitabine 1000 mg/m2 bid on days 1–14 q3w). After three cycles, response was evaluated by a multidisciplinary team. Patients who were progression-free and metastasectomy candidates received one cycle of XELOX before undergoing surgery 3–5 weeks later, followed by four cycles of bevacizumab + XELOX. Results: A total of 83 patients entered the study; 68 were eligible for RECIST, 67 for CTMC, and 51 for pathological response evaluation. Of these patients, 49% had a complete or partial RECIST response, 91% had an optimal or incomplete CTMC response, and 81% had a complete or major pathological response. CTMC response predicted 37 of 41 pathological responses versus 23 of 41 responses predicted using RECIST (p = 0.008). Kappa coefficients indicated a lack of correlation between the results of RECIST and morphological responses and between morphological and pathological response rates. Conclusion: CTMC may represent a better marker of pathological response to bevacizumab + XELOX than RECIST in patients with potentially-resectable CRC liver metastases. View Full-Text
Keywords: metastatic colorectal cancer; neoadjuvant chemotherapy; bevacizumab; antiangiogenics; computed tomography-based morphological criteria metastatic colorectal cancer; neoadjuvant chemotherapy; bevacizumab; antiangiogenics; computed tomography-based morphological criteria
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Vera, R.; Gómez, M.L.; Ayuso, J.R.; Figueras, J.; García-Alfonso, P.; Martínez, V.; Lacasta, A.; Ruiz-Casado, A.; Safont, M.J.; Aparicio, J.; Campos, J.M.; Cámara, J.C.; Martín-Richard, M.; Montagut, C.; Pericay, C.; Vieitez, J.M.; Falcó, E.; Jorge, M.; Marín, M.; Salgado, M.; Viúdez, A., on behalf of the Spanish Multidisciplinary Group on Digestive Cancer (GEMCAD); Correlation of RECIST, Computed Tomography Morphological Response, and Pathological Regression in Hepatic Metastasis Secondary to Colorectal Cancer: The AVAMET Study. Cancers 2020, 12, 2259.

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