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Radiology Assessment — SCE Medical Oncology MCQ

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ModerateClinical Trials & StatisticsRadiology AssessmentSCE Medical Oncology

A 58‑year‑old woman with metastatic non‑small‑cell lung cancer is receiving pembrolizumab plus chemotherapy. After 4 cycles, her restaging CT shows target lesions have decreased by 30%, but two new small lesions have appeared. She remains clinically well. According to RECIST 1.1, what is the response assessment?

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Correct answer: D — Progressive disease (PD) – new lesions define progression regardless of shrinkage of target lesions

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

Under RECIST 1.1, the appearance of new lesions automatically defines progressive disease (PD), regardless of shrinkage in target lesions. Although a 30% reduction in target lesions would normally indicate a partial response, the emergence of new lesions overrides this and mandates classification as PD. Option B is incorrect because RECIST 1.1 provides explicit guidance. Options C, D, and E ignore the significance of new lesions and are therefore incorrect.

Reference: BMJ Open 2022: Definition of PD per RECIST 1.1 includes new lesions; and J Immunother Cancer 2022: RECIST 1.1 defines PD by appearance of ≥1 new lesion(s).