Evaluating treatment response

Ding, H., Kudo, M., Onda, H., Suetomi, Y., Miuami, Y., Maekawa, K. Contrast-enhanced subtraction harmonic sonography for evaluating treatment response in patients with hepatocellular carcinoma. Amer. X. Roentgenol. 2001 176 661-666... 

Evaluate patient response and devise alternative treatment regimens for non-responding... 

Evaluate the response to treatment. Did the patient experience a complete response, partial response, stable disease, or disease progression How does this change future treatment ... 

Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000 92(3) 205-216. 

Ultrasensitive assays for PSA contribute to the earlier detection of prostate cancer relapse and (or) residual disease in prostatectomized patients as well as the more timely evaluation of response to current therapies. PSA determinations can be useful in detecting metastatic or persistent disease in patients following surgical or medical treatment of prostate cancer. Persistent elevation of PSA following treatment, or an increase in the pretreatment PSA concentrations, is indicative of recurrent or residual disease. Hence, PSA is widely accepted as an aid in the management of prostate cancer patients, and serum levels are most useful when sequential values are obtained and monitored over time. After complete removal of the prostate gland (radical prostatectomy), PSA levels should become very low or undetectable. A rise of the serum PSA level in prostatectomy patients indicates residual prostate tissue, recurrence, or metastasis of the disease (13, 16, 24, 36). 

Patients are evaluated for response at the end of four cycles or, if treatment is shorter, at the end of treatment. 

Thus, Lind showed the importance of the comparative trial and Evans and Hoyle showed the importance of the placebo effect in evaluating drug response. Gold et at. then showed the importance of observer bias and introduced the concept of the double-blind study in 1937 in a study of treatments for angina patients. They wrote ... 

Zinzani et at. showed in a study of 75 patients with malignant lymphomas that [ F]-FDG-PET positivity after induction of treatment is highly predictive for the presence of residual disease, with significant differences in terms of recurrence free survival (9% vs. 91%). Conventional imaging methods such as CT and MRI cannot differentiate reliably between scar tissue and vital tumor tissue. Therefore, [ F]-FDG-PET was recently introduced into clinical routine for therapy control and evaluation of early treatment response [91]. 

Aggression is an important component of mood disorders. Thus, a measure that captures the frequency and severity of the child s outbursts, such as the Overt Aggression Scale (OAS Yudofsky et ah, 1986), may be useful. This rating was evaluated in one inpatient study, and appears to be reliable and valid (Kafantaris et ah, 1996). Behavior disorder rating scales that measure ADHD and ODD are also likely to be useful. As noted above, our clinic uses a combined Child and Adolescent Symptom Inventory both at baseline and to follow treatment response, as it provides a comprehensive rating of symptoms (Grayson and Carlson, 1991 Gadow et al., 1999). 

Our results demonstrated that the identified subsets of the activated protein kinases significantly increased the accuracy of clinical outcome predictions. Most notably in the study, we evaluated protein phosphorylation levels instead of total protein expression levels. Protein phosphorylation and dephosphorylation are well-characterized biochemical processes for protein kinases to conduct cellular signal transduction. Phosphorylation at certain tyrosine, serine, or threonine residues in kinases is a key step for their activation, and the measurement of these phosphorylations reflects their functional status in vivo. Thus, the protein kinase phosphorylation-based tissue microarray more accurately reveals the molecular mechanisms of breast cancers, and more accurately predicts the individualized survival and treatment response. 

The currently available data on the impact of 3R/3R 28 bp promoter genotype in ALL treatment response are summarized in Table 2. Krajinovic et al. evaluated 205... 

In addition to the frequent concerns of sample size and MTX dosing, clinical variation in the use of leucovorin may also confound these analyses. Furthermore, the Shimaski et al. study may be subject to treatment period effects as anti-emetic practices change over treatment eras (12). As noted by Laverdiere, prospective studies evaluating multiple folate pathway polymorphisms will be necessary to define clearly the relationship between the RFC G80A polymorphism and ALL treatment response (24). 

Once determined, the concentration (as determined above) is multiplied by the response factor. This quantification technique is used when the primary objective is to evaluate treatment effects on lipid oxidation, and greater accuracy is desired. 

Hannon et al. (H2) evaluated the response to estrogen substitution therapy after 6 months of treatment by comparing the measurement results with the values before treatment, with respect to the critical differences. The effectiveness of therapy was best followed by the values of osteocalcine and PINP (87% of the results with the drop below the values CD percent). Collagen degradation products U-NTx/Cr and U-CTx/Cr showed only 27% and 18% responses to the treatment, respectively BMD change was significant only for the lumbar spine area in 36% of cases. No answer was reached by measuring the total and femoral value of BMD. 

Medication adherence and tolerance should be evaluated at each visit. Central DXA BMD measurements can be obtained every 1 to 2 years for monitoring bone loss and treatment response. More frequent monitoring may be warranted in patients with conditions associated with higher rates of bone loss (e.g., glucocorticoid use, after transplantation). 

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