Revisions to the International Neuroblastoma Response Criteria

A consensus statement from a National Cancer Institute–sponsored clinical trials planning meeting, reported in the Journal of Clinical Oncology by Park et al, presents revisions to the International Neuroblastoma Response Criteria (INRC) for assessing treatment response in patients with neuroblastoma.

The revision process involved multidisciplinary investigators from 13 countries, who reviewed data from published trials performed through cooperative groups, consortia, and single institutions. Monthly international conference calls were held from 2011 to 2015, with consensus on revisions being reached through review by working group leadership and the National Cancer Institute Clinical Trials Planning Meeting leadership council. Key revisions are reproduced/summarized here.

Key Revisions

  • Overall response in the revised INRC will integrate tumor response in the primary tumor, soft-tissue and bone metastases, and bone marrow.
  • Primary and metastatic soft-tissue sites will be assessed using Response Evaluation Criteria in Solid Tumors and iodine-123 (I-123)–metaiodobenzylguanidine (MIBG) scans or [18-F]fluorodeoxyglucose–positron emission tomography (FDG-PET) scans if the tumor is MIBG-nonavid.
  • I-123 MIBG scans, or FDG-PET scans for MIBG-nonavid disease, replace technetium-99m diphosphonate bone scintigraphy for osteomedullary metastasis assessment.
  • Bone marrow will be assessed by histology or immunohistochemistry and cytology or immunocytology.
  • Bone marrow with ≤ 5% tumor involvement will be classified as minimal disease.
  • Urinary catecholamine levels will not be included in response assessment.
  • Overall response will be defined as complete response, partial response, minor response, stable disease, or progressive disease.

The authors concluded: “These revised criteria will provide a uniform assessment of disease response, improve the interpretability of clinical trial results, and facilitate collaborative trial designs.”

The work was supported by the National Cancer Institute Pediatric and Adolescent Solid Tumor Steering Committee, Alex’s Lemonade Stand Foundation, Ben Towne Foundation, EVAN Foundation, Cancer Research UK Institute of Cancer Research (ICR), and National Institute for Health Research Research Methods Programme/ICR Biomedical Research Centre.

Julie R. Park, MD, of Seattle Children’s Hospital, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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