Early Tumor Shrinkage and Depth of Response as Predictive Markers of Treatment Response and Prognosis in Solid Tumors

Background

Evaluation of tumor efficacy is central to cancer care. Progression-free survival (PFS) is widely used as an early surrogate for treatment effectiveness, but more timely and reliable biomarkers are needed. Early tumor shrinkage (ETS) and depth of response (DpR) have emerged as promising predictors: ETS reflects early treatment sensitivity at first radiologic assessment, whereas DpR quantifies the maximum tumor reduction and may capture the durability of benefit.

Methods

We conducted a narrative synthesis of clinical studies assessing ETS and/or DpR across solid tumors, focusing on their definitions, measurement under RECIST, and associations with PFS and overall suvival (OS). We also summarized advances in imaging and multidimensional assessment framworks that could improve the accuracy and clinical utility of these indicators, and highlighted sources of heterogeneity and current gaps.

Results

Across multiple retrospective and post-hoc analyses, ETS provides an early signal that identifies patients more likely to benefit from therapy and can inform treatment adaptation. DpR shows consisten correlations with long-term outcomes and complements PFS by reflecting the magnitude of tumor control. Both ETS and DpR demonstrate predictive value for PFS and OS; however, variability in cut-offs (e.g., ETS 20%–30%), timing of assessments, tumor types, and treatment modalities limits comparability. Emerging imaging technologies and composite response frameworks offer opportunities to enhance measurement precision and reproducibility.

Conclusions

ETS and DpR are promising, clinically interpretable markers for monitoring treatment effcacy and prognosis. Standardized definitons, prospective validation, and integration with molecular and imaging biomarkers (e.g., ctDNA, radiomics, and machine—learning—enhanced imaging) are needed to refine their application and solidify their role in routine cancer therapy monitoring.