RECIP Criteria
Response Evaluation Criteria In PSMA-PET imaging (RECIP) is the first evidence-based standardized response evaluation framework developed for PSMA PET imaging. RECIP was developed as a result of a multidisciplinary collaboration among nuclear medicine specialists, radiologists, urologists and medical oncologists.
Development of RECIP was designed in three phases:
Evidence-based development of criteria - 4 steps
Occurrence of new lesions on follow-up PSMA PET scan was associated with shorter survival.
Tumor segmentation on PSMA PET was performed using a semi-automatic software. PSMA-positive total tumor volume (PSMA-VOL) was derived and percentage change between baseline and follow-up scan was calculated.
Progression by PSMA-VOL was associated with shorter survival.
A significant amount of men (11%) had partial response in PSMA-VOL but occurrence of new lesions. This scenario is not uncommon in clinical practice and often leaves treating physician in a clinical dilemma.
Occurrence of new lesions was combined with changes in PSMA-VOL to develop RECIP 1.0.
Comparison with established criteria in solid cancers
124 men with mCRPC treated with Lu-PSMA radioligand therapy and received PSMA PET at baseline and at interim after 2 cycles
Discrepancies in classifying PD vs No-PD were observed in 20-26% of patient population.
Men who had PD by aPCWG3, aPERCISTor PPP but No-PDby RECIP had longer survival compared to men who had PD byboth criteria. Only one men had RECIP-PD and No-PDby other criteria.
These findings suggest that aPERCIST, aPCWG3 or PPP may overcall progression and can lead to premature discontinuation of treatment.
Clinical Implementation
Tumor segmentation tools are not available widely in clinical practice, hence Gafita et al. evaluated whether changes in total tumor burden can be determined visually by interpreting physicians and combined with status of occurrence of new lesions (visual RECIP 1.0).
94% agreement between visual RECIP 1.0 and quantitative RECIP 1.0 when evaluating RECIP-PD vsRECIP-noPD
Visual RECIP 1.0 is prognostic for overall survival and can be used immediately in clinical practice.
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