Tumor Response - Assess Response

tumor response

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Terms and meaning
Abbreviations
Use and Limitations

TERMINOLOGY:

Name	Description
Adjuvant therapy	Treatment used in addition to main definitive treatment to reduce risks of cancer recurrence. It usually refers to hormone therapy, chemo, radiation therapy, or other treatments given after surgery to increase the chances of cure.
Alopecia	Alopecia means hair loss. This may be an adverse effect to some, not all cancer treatments.
Anemia	Result of having too few red blood cells or a low red blood cell count. This is commonly measured as hemoglobin.
Antibody	Antibody also called immunoglobulin is somewhat Y shaped protein produced in the body which recognize a specific molecular target (called epitope) on germs and some unwanted cells. This immune recognition is a component of immune response against those targets.
Anti-emetic	A drug or medication that prevents or relieves nausea and vomiting.
Area under the curve (AUC)	Area under the curve (also called area under the concentration-time curve) reflects the total drug exposure to the body across time. It is dependant on the bioavailability, rate of elimination and dose of the drug administered. Mathematical formulas may be used to estimate AUC when several variables noted above are known.
Benign	Non-cancerous. A condition that is not malignant. A benign growth is a non-cancerous tumor which does not spread.
Blood count	Refers to number or amount of blood cells. This is commonly measured as CBC or complete blood count which includes red blood cells, white blood cells and platelets.
Bone marrow	A tissue present inside certain bones where blood cells are produced.
Cancer	A general term to indicate abnormal growth of cells many times resulting in a lump or a mass which has the ability to invade and spread locally and to other parts of the body. Some cancers such as blood or bone marrow cancers may not result in measurable lump or mass and may manifest as increased cells in the blood and/or in the bone marrow.
CAR-T therapy	Please see immunotherapy for details.
Cellular therapy	Please see immunotherapy for details.
Chemotherapy	Chemotherapy in general are the drugs (mostly cytotoxic) used to treat cancer. It is often abbreviated as chemo. Oxford dictionary defined chemotherapy as "The treatment of disease by the use of chemical substances, especially the treatment of cancer by cytotoxic and other drugs".
Chromosomes	Thread-like strands that carry genetic information. They are found in the nucleus, or center part, of a cell. Humans have 23 pairs of chromosomes, one member of each pair from the mother, the other from the father. Each chromosome can contain hundreds or thousands of individual genes.
Clinical trials	Medical research studies done in patient volunteers. Each study is designed to answer scientific questions and find better ways to detect, prevent, or treat cancer and/or its side effects.
Combination chemotherapy	The use of more than one chemo drug to treat cancer
Complementary and alternative medicine	Ways of dealing with disease other than those used by doctors in standard medicine. This term covers a broad range of tested and untested methods, such as herbs/vitamins/minerals, mind/body/spirit, diet and nutrition, physical touch, and biological methods.
Confidence Interval	Confidence Interval (CI) is used to measure the precision of statistical estimate. CI is a range of values that is likely to include the true value. Hence, if the confidence interval includes 1, then the hazard ratio is not significant. A commonly used CI is a 95% confidence interval which has a probability of containing the population mean 95% of the times.
Contralateral	On the opposite side
Cytogenetic Response	In chronic myeloid leukemia, response to treatment is assessed using several criteria with varying sensitivity to assess response. Cytogenetic response is to assess response based on percentage of Philadelphia chromosome positive (Ph+) cells (with conventional cytogenetics) or BCR-ABL1-positive cells (on FISH analysis). Various cytogenetic responses are: no response (>95 percent), minimal (66 - 95 percent), minor (36 - 65 percent), major (1 - 35 percent), and complete (0 %).
Disease-Free Survival	Please see "relapse-free survival"
Disease specific survival (DSS)	Disease specific survival is the percentage of people who have not died from the specified disease in a defined period of time.
Event-free survival	Event-free survival (EFS) is the length of survival after definitive cancer treatment to disease progression, death, or discontinuation of treatment for any reason or initiation of a new treatment without documented progression. EFS is not commonly used and similar to progression free survival.
Fatigue	The feeling of being tired physically, mentally, and/or emotionally.
Growth factors	Growth factors (also known as colony-stimulating factors) are substances that stimulate the production of blood cells in the bone marrow. They may help prevent or recover from low blood counts as a result of chemotherapy and radiation therapy.
Hazard Ratio (HR)	Hazard ratio (HR), a type of relative risk, a measure of an effect of an intervention on an outcome/event over time. Hazard represents the probability of an event such as relapse after the intervention. Many survival analysis are reported as Hazard ratio. HR is the ratio of chance of an event occurring (hazard rate) in the treatment group ÷ chance of an event occurring (hazard rate) in the control group. Hence, HR of 1 indicates that the event rates are same in both treatment and control groups. HR less than one indicates less patients in the treatment group are experiencing an event compared to the control group. A hazard ratio of 0.70 may mean that the study drug provides 30% risk reduction compared to the control treatment. Similarly, 0.50 may indicate 50% reduction. HR greater than 1 indicates more patients in the treatment experienced an event compared to control arm.
Hormonal Therapy	Use of medications which work by increasing or decreasing hormonal functions. Several hormones make some cancer cells multiply and grow. In cancer treatment, hormonal therapy usually imply methods to reduce hormones or their function.
Hormone	A hormone is a chemical or a molecule which are produced in endocrine glands. These are released into blood and influence or control functions of other body organs and tissues.
Hormones	Natural substances released by an organ that can influence the function of other organs in the body and the growth of some types of cancer
Immunotherapy	Immunotherapy or immune therapy is a category of treatment where drugs or cellular therapy is used to harness, augment, enable, modulate or add additional capabilities to body’s natural immune functions to achieve a desired therapeutic effect. Cellular therapy is the use of externally stimulated, multiplied, augmented and/or genetically modified cells (mostly immune cells) rather than chemicals or drugs to achieve therapeutic objectives. CAR-T cell therapy where T-cells (immune cells) are genetically modified to express a special receptor called a chimeric antigen receptor (CAR) is a type of cellular therapy.
Infusion	Slow and/or prolonged intravenous (IV) delivery of a drug or fluids
Injection	Using a syringe and needle to push fluids or drugs into the body; often called a shot
Intramuscular	Inside a muscle. Usually refers to a medication administered into a muscle.
Intrathecal	Into the spinal fluid (also called cerebrospinal fluid or CSF)
Intravenous (IV)	Inside a vein. Usually refers to a medication administered inside a blood vessel (vein).
in vitro	A process (usually a biological process) occurring or happening outside of a living organism, such as in test tubes or tissue cultures etc.
in vivo	A process (usually a biological process) occurring or happening in a living organism.
Ipsilateral	On the same side
Major Response	Commonly indicate responses that include complete response (CR) as well as partial responses (PR). Some cancer response assessments include responses such as pathologic complete response (pCR), unconfirmed CR, very good partial responses (VGPR) etc. which may be included under 'major response'. Stable disease (SD) is usually not included.
Malignant	In cancer medicine or oncology, malignant or cancerous indicate unwanted excessive multiplication of cells which have the ability to invade and spread. Cancer is the result of malignant cells which multiply uncontrollably.
Median not reached (PFS, statistics)	Median is reached when 50% of patients have experienced an event. Median not reached means 50% of patients have not experienced a defined event in that group.
Metastasis	The spread of cancer or malignant cells to other areas of the body, often through the lymph system or bloodstream
Molecular Response	In chronic myeloid leukemia, response to treatment is assessed using several criteria with varying sensitivity to assess response. Molecular response (MR) is used to assess response based on level of detection of BCR-ABL1 transcripts in sensitive quantitative PCR test. BCR-ABL1 transcripts are commonly reported using International Scale (IS) (ratio of BCR-ABL1 transcripts to ABL1 transcripts) on a log scale. Early Molecular Response (EMR): BCR-ABL1 transcripts (IS) ≤ 10% at 3 and 6 months. Major Molecular Response (MMR): BCR-ABL1 transcripts (IS) ≤ 0.1% or ≥ 3 log reduction in BCR-ABL1 mRNA if IS is not available. Complete Molecular Response (EMR): Depending on the level of detection and sensitivity of PCR assay, various types of complete molecular responses are defined. Below noted are from UpToDate (accessed: July 16, 2019): "* MR2 – Detectable disease at a level of ≤1 percent on the IS (≥2 log reduction from the standardized baseline). This level of response roughly corresponds to a 'complete cytogenetic response.' * MR3 – Detectable disease at a level of ≤0.1 percent on the IS (≥3 log reduction from the standardized baseline). This level of response has been termed a 'major molecular response.' * MR4 – Either detectable disease at a level of ≤0.01 percent on the IS (≥4 log reduction) or undetectable disease in cDNA with ≥10,000 ABL1 transcripts. This level of response requires that the assay being used is sensitive enough to detect a single abnormal transcript amongst 10,000 normal ABL1 transcripts. * MR4.5 – Either detectable disease at a level of ≤0.0032 percent on the IS (≥4.4 log reduction) or undetectable disease in cDNA with ≥32,000 ABL1 transcripts. This level of response requires that the assay being used is sensitive enough to detect a single abnormal transcript amongst 32,000 normal ABL1 transcripts."
Monoclonal antibodies	Monoclonal antibodies are antibodies which are produced by the same clone of cells that targets specific molecular target (called epitope). Monoclonal antibodies can be engineered and designed against a specific molecular target and commercially produced for treatment of diseases including cancers. These fall under targeted therapy category along with other types of targeted therapy.
Neoadjuvant therapy	Treatment, such as chemotherapy, hormone therapy, or radiation therapy, given before the main treatment is done
Objective Response rate	Is the response to a treatment as measured by the tumor measurements or other measurable parameters.
Odds Ratio	Odds ratio (OR) is the ratio of odds of an outcome in the presence and in the absence of intervention. Odds of an outcome is the ratio of the probability that the outcome happening / probability of the outcome not happening. OR indicates strength of association (not necessarily causation) between outcome and intervention. Odds ratio (OR) of 1 indicate no effect on the odds of outcome, >1 indicates higher odds and <1 indicates lower odds of the outcome with the intervention.
Oncologist	A doctor or a physician with special training in the diagnosis and treatment of cancer
Orally (PO)	Taken by mouth
Peripheral neuropathy	Damage to the nerves that usually starts in the hands and/or feet. Symptoms of neuropathy include numbness, tingling, burning, and/or weakness etc. There are several causes of neuropathy including treatment side effects.
Placebo	Placebo is a substance or treatment that is considered safe with no therapeutic effect. placebo effect is the benefit attributable to the psychological or idea of taking a treatment and not due to real therapeutic effect of the treatment. Placebo is sometimes used as a control while testing new drugs which may help assess and control for placebo effect and make data more meaningful.
Platelets	A type of blood cells that usually serve as the first responders when there is a damage to the lining of blood vessels. They help blood clot and stop bleeding.
Platinum sensitivity	Platinum sensitivity is helpful in the management of tumors sensitive to platinim compounds. The following terms are commonly used in the management of ovarian, fallopian tube or peritoneal cancer. 1. Platinum-sensitive (platinum-free interval of six or more months) 2. Platinum-resistant (platinum-free interval of less than six months) 3. Platinum-refractory (disease progression while on platinum based therapy).
Port	Also called a mediport is a devise that is inserted usually under the skin to connect to central veins (a type of central venous catheter or CVC). The port can be accessed through the skin with a special needle and provides easy and reliable access to central veins to facilitate administration of medications safely. It can also be used to draw blood, administer fluids or blood products.
Progression free survival (PFS)	The length of time during and after the treatment for a disease, such as cancer, that a person lives without disease getting any worse than before (without progression). Progression-free survival is one way to assess effect of new treatment on the disease condition. PFS is defined as the time until objective tumor progression or death.
p-value	p-value is a statistical probability value. p-value indicates the probability of differences between two groups to be a random and/or unrelated. Smaller the value, less likely the difference to be a random occurance. Generally P < 0.05 (< 5% chance of being wrong) is considered minimal threshold to consider statistically significant and P < 0.001 as statistically highly significant. In statistics, null hypothesis is a default starting hypothesis which states there is no difference between the groups to be compared and any difference is due to some form of error. To show a meaningful difference between the groups, statistical tests/ analysis must prove that null hypotheses is worng. p-value indicates the chances that null hypothesis is true. p-value of <0.05 indicates less than 5% chances that null hypothesis is true (less than 5% chances that there is no difference between the groups).
Radiation therapy	The use of high-energy rays or subatomic particles to treat disease.
Radiographic Progression Free Survival (rPFS)	Usually indicate time from randomization to evidence of radiographic disease progression or death.
Red blood cells	Red blood cells or RBCs are a type of blood cells which are commonly measured as hemoglobin. These cells carry oxygen from the lungs and deliver to tissues throughout the body. Anemia is a condition of low red blood cells.
Relapse-free survival	Relapse-free survival also known as disease-Free Survival is the length of survival after definitive cancer treatment without any evidence of cancer relapse (or recurrence).
Relative risk (RR)	Relative risk (RR), also called Risk Ratio is the ratio of probability of an outcome in one group divided by the probability of the same event in the control group. This is not same as Hazard ratio (HR). However, this is used in a similar sense. Choice of HR or RR as a measure is decided by statistitians depending on the contexts of the research data. RR of 1 indicate no difference between the groups. RR of less than one indicate lesser probability of the outcome than the control group. Similarly RR of greater than one indicate greater probability than the control group.
Remission	The partial or complete disappearance of signs and symptoms of disease
Residual cancer burden (RCB)	Residual cancer burden is a measure of pathologic response to assess effectiveness of pre-surgical therapy. Factors used in calculating RCB include pathologic size and cellularity of primary tumor as well as number and size of lymph node metastases. Depending on the amount of residual disease, RCB is categorized 0 (no residual disease or pathologic complete response) or RCB I, II or III (extensive residual disease).
Stomatitis	Sores on the lining of the mouth
Surgery	Surgery is a medical treatment which involves use of anesthesia and cutting open body parts. In cancer treatment surgery is done to remove cancerous growth with an effort when possible to remove all the known cancer growths with good negative margins.
Targeted therapy	Targeted therapy is a broad category which indicate use of drugs that work by targeting specific molecular targets. These molecular targets could be inside or outside of the cells including non cellular molecules of the body.
Time to Progression (TTP)	Time to progression (TTP) is defined as the time until objective tumor progression. TTP does not include deaths. TTP does not count patients who die from other causes but is otherwise a close equivalent to PFS
Topical	Usually refers to a medication which is applied on the surface of the skin.
Tumor	An abnormal growth (lump or mass) of cells or tissues. Tumors are either benign (not cancer) or malignant (cancer).
White blood cells (WBCs)	The blood cells that fight infection

ABBREVIATIONS:

Name	Description
5FU	5-fluorouracil or fluorouracil is an injectable chemotherapy agent.
ADT	Androgen Deprivation Therapy
ALK	Anaplastic Lymphoma Kinase
ALL	Acute Lymphoblastic Leukemia
AML	Acute Myeloid Leukemia disease
AR	Androgen Receptor
ASCT	Autologous Stem Cell Transplant
AUC	Area Under the concentration-time Curve (pharmacokinetics)
AUC	Area Under the Curve (area under the plasma drug concentration time curve) represent total drug exposure across time. AUC is also used to indicate target drug concentration (Ex: carboplatin) to be achieved in the body which can be calculated.
BSC	Best Supportive Care.
CBR	Clinical Benefit Rate. Used similar to DCR (disease control rate) to indicate responses to treatment including complete response AND partial response AND stable disease.
CCyR	Complete Cytogenetic Response. Used in CML to indicate reduction of Philadelphia chromosome positive (Ph+) cells to 0 percent.
CHF	Congestive Heart Failure
CHOP	Abbreviation for chemotherapy regimen: Cyclophosphamide+Adriamycin+Vincristine+Prednisone Drg regimen
CHR	Complete Hematologic Response. Used to assess response in hematologic malignancies. In CML, used to indicate normalization of blood counts and no abnormal immature cells seen in blood.
CI	Confidence interval (to measure the precision of statistical estimate)
CLL	Chronic Lymphocytic Leukemia
CML	Chronic Myeloid Leukemia disease
CNS	Central Nervous System
CPS	Combined Positive Score, a PD-L1 scoring method.
CR	Complete Response
CR1	1st Complete Response
CR2	Complete Response after treatment for relapse
CRC	Colorectal cancer disease
CRh	Complete response with partial hematologic recovery (definitions may vary)
CRi	Complete Remission with incomplete marrow recovery (definitions may vary)
CRPC	Castration Resistant Prostate Cancer
CRR	Complete Response Rate
CRu	CR (complete response) unconfirmed
C_max	Maximum (or peak) serum concentration of a drug after the drug has been administered.
C_trough	Trough (or lowest) serum concentration of a drug before the next dose is administered
DCR	Disease Control Rate. Used similar to CBR (clinical Benefit rate) to indicate responses to treatment including complete response AND partial response AND stable disease.
DFS	Disease Free Survival (Survival without any evidence of cancer recurrence)
DFS	Disease free survival (also known as relapse-free survival)
DLBCL	Diffuse Large B Cell lymphoma disease
DoR	Duration of Response
DSS	Disease specific survival
EFS	Event Free Survival
EGFR	Epidermal Growth Factor Receptor
ER	Estrogen Receptor
FACT score	Functional Assessment of Cancer Therapy. These are questionnaire used to assess patient reported quality of life in patients undergoing cancer therapy. FACT-G ((FACT-General) can be used to assess patients of any tumor type. There are several different sets of questionatres designed to assess quality of life for specific cancers, specific treatment etc. FACT questionnaires generally use 5 point patient scale ranging from 0 (Not at all) to 4 (Very much).
FGFR	Fibroblast Growth Factor Receptor
FGFR1	Fibroblast Growth Factor Receptor 1
FIGO	International Federation of Gynecology and Obstetrics
FIGO staging	FIGO (International Federation of Gynecology and Obstetrics) cancer staging is commonly used in gynecological malignancies.
FL	Follicular Lymphoma
FOLFIRI	Abbreviation used to indicate chemotherapy regimen incorporating 5FU with leucovorin (folinic acid) with irinotecan. FOL (folinic acid or leucovorin)+F (fluorouracil or 5-FU)+ IRI (irinotecan).
FOLFOX	Abbreviation used to indicate chemotherapy regimen incorporating 5FU with leucovorin (folinic acid) with oxaliplatin. FOL (folinic acid or leucovorin)+F (fluorouracil or 5-FU)+ OX (oxaliplatin).
G-CSF	granulocyte-colony stimulating factor
HER-2	Human Epidermal growth factor Receptor-2
HPF	High Power Field (usually 40x magnification in microscope)
HR	Hazard Ratio (Statistical method)
HR	Hormone Receptor
HRD	Homologous Recombination Deficiency. Homologous recombination is a process involved in repair of double-stranded DNA breaks and during cell division. Multiple gene mutations including BRCA1 and BRCA2 etc. may result in HRD.
iDFS	Invasive Disease Free Survival. Similar to DFS. Useful when the cancer included invasive and non-invasive types (Ex. Breast cancer).
IGVH	IGVH of IgVH. Immunoglobulin heavy-chain variable region.
IHC	Immuno-Histo-Chemistry. Immunohistochemistry is a method of staining pathoogy specimen for detection of molecular markers based on antibody binding.
IM	Intramuscular injection
INI1	INI1 (INtegrase Interactor 1) also known as SMARCB1 (SWI/SNF related matrix‐associated actin dependent regulator of chromatin subfamily B member 1) is a part of an essential chromatin remodeling complex involved in multiple pathways that affect DNA structure and function. Gene encoding for INI1 is considered a tumor supressor gene.
IQR	InterQuartile Range (statistics)
IRC	Independent Review Committee
IV	Intravenous (route of administration of a drug)
KIT	KIT (also called CD117, Stem Cell Factor Receptor) is a surface protein receptor tyrosine kinase which mediate actions of stem cell factor (SCF).
KRAS	KRAS is a growth promoting protein enzyme (GTPase) that belongs to Ras superfamily of proteins. Name originated from: Kirsten RAt Sarcoma virus.
LRC	Local regional control (locoregional control)
LVEF	Left Ventricular Ejection Fraction
MaHR	Major Hematologic Response. Used in CML to indicate normalization of blood counts.
MCyR	Major Cytogenetic Response. Used in CML to indicate reduction of Philadelphia chromosome positive (Ph+) cells to 1 to 35 percent.
MDS	Myelodysplastic syndromes disease
MFS	Metastasis Free Survival. A duration from treatment or randomization to first evidence of metastasis or death.
MMR	Mismatch Repair (gene)
MMR	Major Molecular Response (see "Molecular Response" under Terminology link)
MPN	Myeloproliferative Neoplasms. Also refered to as myeloproliferative diseases (MPDs) are a group of bone marrow malignant disorders including chronic myelogenous leukemia, polycythemia vera, essential thrombocythemia and other conditions. disease
MRD	Minimal Residual Disease
mRECIST	mRECIST is modified RECIST developed for the assessment of hepatocellular carcinoma.
MRI	Magnetic Resonance Imaging
MSI	Microsatellite Instability
muts/Mb	Mutations per megabase (of DNA)
MZL	Marginal Zone Lymphoma disease
NCCN	National Comprehensive Cancer Network
NED	No Evidence of Diseae
NHL	Non-Hodgkin's Lymphoma
NI	Non-inferiority or Non-inferior. It is generally used to indicate that the treatment studied is statistically NOT inferior to comparator treatment.
NI	Not-inferior/ Non - inferiority
NOS	Not Otherwise Specified
NS	Statistically NOT significant
NSAI	Non-steroidal aromatase inhibitors (Ex: letrozole or anastrozole)
NSCLC	Non Small Cell Lung Cancer disease
ORR	Objective response rate
OS	Overall Survival
pCR	Pathologic Complete Response
PD1	Programmed cell death protein 1 (surface protein receptor) involved in immune response.
PDGFRA	Platelet-derived growth factor receptor alpha (PDGFRA or PDGFRα) is a cell surface receptor which binds to and mediate actions of platelet-derived growth factors (PDGFs).
PD-L1	Programmed death ligand-1, a protein that binds to PD1 receptor.
PET	Positron Emission Tomography (scan)
PFS	Progression Free Survival
Ph+	Philadelphia chromosome positive. Philadelphia chromosome is abnormal chromosome 22 in which part of chromosome 9 (containing ABL1 gene) is transferred to chromosome 22 (containing BCR gene) resulting in fusion gene called BCR-ABL1.
PI	Probability interval
PR (PRR)	Partial response (Partial Response Rate)
PSA	Prostate-specific antigen
PSMA	Prostate Specific Membrane Antigen (a transmembrane protein that is expressed in prostate cancer)
p-value	Statistical probability value (see more info under "Terms and Meaning" link
q	Every
q14d	Every 14 days
q2wk	Every 2 weeks
q3wk	Every 3 weeks
q.d	Every day
q.o.d	Every other day
QOL	Quality of Life
q.wk / qw	Once per week
R0 (resection)	R0 refers to complete surgical resection or removal of the tumor without clinical, gross or microscopic evidence of disease/tumor.
R1 (resection)	R1 refers to surgical resection with microscopic residual disease/tumor.
R2 (resection)	R2 refers to surgical resection with macroscopic or obvious residual disease/tumor.
RAI	Radioactive Iodine. Used in the treatment of some thyroid cancers.
RBC	Red Blood Cell
RCB	Residual Cancer Burden (a measure of residual cancer at surgery after pre-surgical treatment)
RCT /RCTs	Randomized Controlled Trial / Randomized Controlled Trials
RECIST	Response Evaluation Criteria In Solid Tumors (RECIST) is a set of criteria to assess response of treatment developed and published in 2000.
RECIST 1.1	Is the revised RECIST guielines updated in 2009 to assess response
RET gene	Rearranged during Transfection (RET) gene
RFS	Relapse (recurrence) Free Survival (also known as disease-free survival)
rPFS	Radiographic Progression Free Survival
RR	Relative Risk (Statistical method)
RS	May indicate Recurrence Score (RS) based on on Oncotype Dx test result.
SCLC	Small Cell Lung Cancer disease
sCR	Stringent Complete Response. In multiple myeloma: "In addition to complete response criteria, these patients have a normal free light chain (FLC) ratio and have no clonal cells by bone marrow immunohistochemistry or immunofluorescence. The latter is achieved if there is a kappa/lambda ratio of ≤4:1 or ≥1:2 after examination of a minimum of 100 plasma cells."(Reference: UpToDate).
SD	Stable Disease. The disease that has remained stable without progression.
SQ	Subcutaneous injection
TKI	Tyrosine Kinase Inhibitor (TKI). TKIs are drugs that work by inhibiting various tyrosine kinase enzymes.
TTF	Time-to-treatment failure (TTF) is variably defined. It may be used to indicate an interval from initiation of treatment to its premature discontinuation. The treatment may be defined as first or subsequent treatment. Discontinuation could be due to several reasons including toxicity or death.
TTP	Time to progression. May also be used to indicate a disease condition thrombotic thrombocytopenic purpura.
TTR	Time to response
VEGF	Vascular Endothelial Growth Factor
VGPR	Very Good Partial Response. Commonly used to assess response in multiple myeloma.

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Molecular Types
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- BRAF V600E mutation positive
- Cancers associated with von Hippel-Lindau disease
- HER2-positive (IHC3+)
- microsatellite instability - high (MSI - H) or mismatch repair deficient (dMMR)
- Neurotrophic receptor tyrosine kinase (NTRK) gene fusion
- RET fusion-positive
- Tumor mutational burden-high (≥10 muts/Mb)
Prognostic/predictive tests
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- Oncotype Dx

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Cancer treatment overview

General aspects of cancer and its treatment are reviewed in the previous section. In most situations, planning proper cancer treatment requires adequate information on cancer staging, pathologic and molecular test results, imaging, laboratory results and patient factors such as comorbid conditions. Since several different treatment modalities may be utilized singly or in combination, input from several specialists may be necessary. Sometimes, treatment plan may have to be modified depending on tolerance and response to initial treatment.

Clinical research

Medications for potential treatment of human diseases are developed in various phases of research. First, chemical or biological molecules are identified based on various factors including their physical and chemical properties. Their biological activity and possible toxicity are then assessed using various pre-clinical (prior to testing on humans) studies including in animals and in tissue cultures. Computer modelling may be used.

Once a promising molecule is identified, it undergoes several phases of clinical research generally ranging phases 1 through 4. Each phase has specific purposes and limitations. Clinical trials may have different designs and may not always fit into a specific phase. This process from preclinical to drug approval may take several years. Clinical trials are highly regulated, expensive and are carefully designed to get most accurate information with least amount of bias possible.

Clinical trial results

Management of human diseases are guided by scientific or historical evidence that a treatment works and adequate knowledge of benefits vs risks. Such evidence may come from various forms of research. Results of scientific research are commonly presented and discussed in scientific conferences and/or published in various scientific publications many of which are indexed in PubMed. PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institutes of Health maintains the database as part of the Entrez system of information retrieval.

Limitations of clinical research

Research data, no matter how scientifically rigorous, will have many limitations. Such limitations may include patient factors (distribution of age, sex, race, comorbidities among study groups), study design (randomized, case control, epidemiological etc. each with its own advantages and limitations) and may other factors. A research study on a cancer type may have included all the molecular subtypes of that cancer which may respond differently for the same treatment. This data may overestimate the benefit for some subtypes while underestimating the benefits for the other subtypes. There are many forms of bias which also affect the data integrity.

Since all research data have inherent limitations, using these data for an individual adds additional bias and limitations. Clinical trial data is a collective wisdom based on population study. Individuals in the population have wide variety of individual variations in genetics, comorbidities, tolerance, response and personal preferences.While research data is currently the most scientific evidence based data available, this comes with significant limitations for individual use. Hence one has to be careful in interpreting scientific data for individual treatment.

It is important to note that each clinical research is done to answer a specific clinical question and not designed to compare the data to another trial. In many situations, we are presented with several treatment choices with many clinical research trials supporting those treatments. When only one treatment need to be chosen among many choices, these choices need to be compared overall for their benefits and risks to make the right choice.

Limitations of data

The data presented here are from clinical research (trials) done on adult (unless specified) patients and volunteers. These are select group of clinical trials which may provide scientific basis for use of specific medications or regimen as cancer treatment. When several trials are available for one treatment, only one or few may be presented. This database does not include all the available clinical trial results. Information of adverse effects and additional information is commonly presented with minimal or no modifications to improve accuracy. Reference link for the original source of data is provided. When using these data, always refer to the original data and original article for the most accurate and complete information. Information on drug data particularly newer agents are commonly obtained from drug monograph.

Even though the research trials are not designed to be comparable, when several treatment choices are available, we may need to analyze risks vs benefits in totality and compare/analyze to make right treatment choice. It is important to look at the data in totality and the clinical context rather than just compare number to number. There are several limitations in using the data presented here including limited number of data sets. Interpretation of enormous scientific data to make the right treatment choice requires professional expertise in conjunction with patient factors and preferences.

The intention of this effort is to present clinical trial data in an easy to visualize format so that a professional can look at available data side by side for easy comparison. Author/scientist's interpretations/opinions may be important and cannot be represented in numbers. Typographic errors can occur in data entry and/or in the original publication. When many data are presented in the original work, only major information may be presented here. Other data not presented here may be relevant for overall interpretation. Sometimes, research done on the same treatment or condition at different times or place may have different findings. All of them may be relevant in overall interpretation. However, only one or few may be presented here.

Treatment decisions should be made in consultation with a physician incorporating individual variables (comorbidities, tumor and personal genetics, tumor characteristics etc.) as well patient preferences. Financial aspects may have to be considered as well. Results of clinical trials are only one of many components in decision making. However, when several treatment options appear reasonable, research data may help to select a treatment that may have higher probability of helping and/or lower probability of harm.

How to use the data

Database can be searched based on disease, drug or regimen. Search box may also be used. Upon searching, research matching the selection is presented in a table format. Major treatment context, medication studied, disease type and other information is shown. Disease conditions and contexts are for adult population unless specified. Using this table, upto 4 specific trial can be selected for viewing data or comparison which are presented in a separate tab.

The selected research data is presented with information including cancer type, additional clinical context if available as well as major outcome measures. Select additional information which may help interpret data (data info), title of the study (Title), summary of side effects when available (ADRs) will popup when cursor hovers over appropriate label. Some trial data are presented in multiple places such as conference presentation, subsequent journal article, drug company data on file and possibly FDA approval data etc. When multiple related data sets are available in the database, link to related data sets is presented under "Related data".

The tern "control arm" is used to indicate either a control arm or a comparator arm. When a study do not identify a treatment arm as either control or a comparator arm, one of the arms will be designated as control arm.

Many commonly used outcome measures are presented using standard abbreviation. Explanations for abbreviations and terminology are presented to some extent under help links. It is important to note that absolute or visual difference between the two arms of the study may not correlate with statistical significance. A small difference which is visually may not be significant could be statistically significant. On the other hand a large difference visually may not be statistically significant. This happens due to differences in the number of patients, duration of follow up and other research related factors. Hence, final interpretation should not be made on visual impression alone.

While the intension is to provide easy visualization and understanding, please note significant limitations of data sets, interpretations and non-comparability. The data should be used by a qualified professional or in consultation with a qualified professional. Please also review disclaimers.