While density decrease is a relatively com mon phenomenon in adva

While density decrease is a relatively com mon phenomenon in advanced melanoma treated with ipilimumab plus bevacizumab, further studies are www.selleckchem.com/products/BI6727-Volasertib.html needed to define its role in assessing anti cancer activity Inhibitors,Modulators,Libraries and therapeutic benefit of the agents and to identify objective imaging marker that can predict outcome during the combined immunotherapy and anti angiogenic therapy. The degree of diameter and density changes in our co hort were similar to the previous report by Gray et al. in their study of metastatic melanoma patients treated with bevacizumab with or without interferon, which reported the average of 2% diameter change and ?7% density change. No lesions or patients in our study met the density response criteria by MASS, indicating that such a marked decrease in density is a rare phenomenon among melanoma patients receiving ipilimumab plus bevacizumab.

Our observation is similar with the report by Gary et al, which had only 1 out of 118 lesions showing marked central necrosis. Density decrease 40HU were more frequent in their cohort and 6 44 patients which could be due to the differ ent therapeutic regimen in the prior report where the ma jority of the patients received Inhibitors,Modulators,Libraries interferon in addition to bevacizumab. When three different criteria for response were used for 59 lesions, the lesion based response rate was 7% by RECIST, 15% by MASS, and 49% by Choi criteria. For the patient based analysis, the re sponse rate was 14% by RECIST and MASS, and 52% by Choi. The in crease in response rate by applying the Choi density criteria indicates that CT density decrease may be a se quela of the anti cancer activity of ipilimumab and beva cizumab therapy.

Similar increase Inhibitors,Modulators,Libraries of response rate was noted in the prior study, in which response rates at the first follow up CT were 7% for RECIST, 14% for MASS, and 34% for Choi criteria. Heterogeneous changes of CT density within same pa tient were Inhibitors,Modulators,Libraries noted in 15% among the patients with more than 1 lesion, while overall assessment using the average density met Choi density response criteria in both patients. Tumoral heterogeneity is an important issue in assessing response to targeted Inhibitors,Modulators,Libraries therapy, and the quantitative imaging approach to address this issue remain to be established. The current standard ap proach including the one used in the present study relies on a certain number of representative lesions to demon strate systemic tumor burden changes, which is associated with inherent limitations.

Further studies are needed to as sess the frequency and impact of heterogeneous density changes during therapy. While different definitions of response can give rise to selleckchem MG132 different rates of response, these modified definitions of response need to be validated by studying association different regimen. Our study also had only 3 MASS responders. High baseline serum lactate dehydrogen ase level was also associated with survival in their study.

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