Timing and extent of response in colorectal cancer: critical review of current data and implication for future trials

Giuseppe Aprile _, Caterina Fontanella, Marta Bonotto, Karim Rihawi, Stefania Eufemia Lutrino, Laura Ferrari, Mariaelena Casagrande, Elena Ongaro, Massimiliano Berretta, Antonio Avallone, Gerardo Rosati, Francesco Giuliani and Gianpiero Fasola

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Oncotarget. 2015; 6:28716-28730. https://doi.org/10.18632/oncotarget.4747

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Giuseppe Aprile1, Caterina Fontanella1, Marta Bonotto1, Karim Rihawi1, Stefania Eufemia Lutrino1, Laura Ferrari1, Mariaelena Casagrande1, Elena Ongaro1, Massimiliano Berretta2, Antonio Avallone3, Gerardo Rosati4, Francesco Giuliani5, Gianpiero Fasola1

1Department of Medical Oncology, University and General Hospital, Udine, Italy

2Department of Medical Oncology, National Cancer Institute, Aviano, Italy

3Gastrointestinal Medical Oncology Unit, National Cancer Institute, Napoli, Italy

4Medical Oncology Unit, San Carlo Hospital, Potenza, Italy

5Department of Medical Oncology, National Cancer Institute, Bari, Italy

Correspondence to:

Giuseppe Aprile, e-mail: [email protected]

Keywords: colorectal cancer, endpoint, response rate, early tumor shrinkage, deepness of response

Received: April 14, 2015     Accepted: July 10, 2015     Published: July 23, 2015


The identification of new surrogate endpoints for advanced colorectal cancer is becoming crucial and, along with drug development, it represents a research field increasingly studied. Although overall survival (OS) remains the strongest trial endpoint available, it requires larger sample size and longer periods of time for an event to happen. Surrogate endpoints such as progression free survival (PFS) or response rate (RR) may overcome these issues but, as such, they need to be prospectively validated before replacing the real endpoints; moreover, they often bear many other limitations. In this narrative review we initially discuss the role of time-to-event endpoints, objective response and response rate as surrogates of OS in the advanced colorectal cancer setting, discussing also how such measures are influenced by the tumor assessment criteria currently employed. We then report recent data published about early tumor shrinkage and deepness of response, which have recently emerged as novel potential endpoint surrogates, discussing their strengths and weaknesses and providing a critical comment. Despite being very compelling, the role of such novel response measures is yet to be confirmed and their surrogacy with OS still needs to be further investigated within larger and well-designed trials.

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