Definition of treatment failure

UpToDate (2015)

In our own practice, we monitor for treatment failure by taking into account serial changes in tumor markers, evidence of disease progression based on serial imaging, and the clinical status of the patient. Some criteria that we use to define treatment failure include any of the following:

  • Clinical deterioration during treatment (ie, increasing disease related symptoms, intolerable treatment toxicities, declining performance status)
  • Evidence of new metastases
  • Increasing size of previously documented metastatic lesions

RECIST criteria

The primary role of Response Evaluation Criteria in Solid Tumors (RECIST 1.1) is to standardize the reporting of results on clinical trials (table 2) [72]. RECIST primarily applies to imaging of metastatic disease, and it encompasses two of the three reasons for treatment failure.

According to RECIST, disease progression on imaging is defined as any of the following:

  • A 20% or more increase in the sum of measurable target lesions compared with the smallest sum previously recorded
  • The appearance of any new lesions
  • Worsening of existing non-target lesions, for example, bone metastases

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