Osteoblastic flare in a patient with advanced gastric cancer after treatment with pemetrexed and oxaliplatin: implications for response assessment with RECIST criteria

• Published in: BMC cancer Vol. 7; no. 1; p. 94
• Main Authors: Amoroso, Vito, Pittiani, Frida, Grisanti, Salvatore, Valcamonico, Francesca, Simoncini, Edda, Ferrari, Vittorio D, Marini, Giovanni
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01.06.2007; BioMed Central; BMC
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - drug therapy; Adenocarcinoma - secondary; Adult; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - secondary; Case Report; Complications and side effects; Dosage and administration; Drug therapy; Glutamates - administration & dosage; Guanine - administration & dosage; Guanine - analogs & derivatives; Humans; Lung Neoplasms - secondary; Lymphatic Metastasis; Male; Organoplatinum Compounds - administration & dosage; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - secondary; Pemetrexed; Radiography; Stomach cancer; Stomach Neoplasms - diagnosis; Stomach Neoplasms - drug therapy; Treatment Outcome; Italy
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/1471-2407-7-94

The RECIST guidelines are commonly used in phase II and III clinical trials. The correct definition of response can be controversial in some situations, as in the case we describe. A 43 year-old man with advanced gastric cancer was enrolled in a phase II trial where he was treated with pemetrexed 500 mg/m2 plus oxaliplatin 120 mg/m2 every 3 weeks. At baseline, the target lesions were lymph-nodes, and the non-target lesions were small pulmonary nodules. At first re-evaluation, the target lesions showed partial response and the non-target lesions showed complete response, but new diffuse osteoblastic lesions appeared. The investigator decided to continue treatment until the second re-evaluation. CT scan confirmed the response of the target and non-target lesions, while the osteoblastic lesions did not change. The appearance of osteoblastic lesions after an active antitumor treatment, a phenomenon known as flare, can complicate the definition of the best overall response using RECIST criteria. This possibility should be considered by oncologists involved in clinical trials.