Patterns of pseudoprogression across different cancer entities treated with immune checkpoint inhibitors
Abstract Background Pseudoprogression (PsPD) is a rare response pattern to immune checkpoint inhibitor (ICI) therapy in oncology. This study aims to reveal imaging features of PsPD, and their association to other relevant findings. Methods Patients with PsPD who had at least three consecutive cross-...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | Cancer Imaging |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40644-023-00580-9 |
| _version_ | 1797806492048424960 |
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| author | Sebastian Mönch Maurice M. Heimer Michael Winkelmann Anne Guertler Max Schlaak Amanda Tufman Najib Ben Khaled Enrico de Toni Christoph B. Westphalen Michael von Bergwelt-Baildon Julien Dinkel Philipp M. Kazmierczak Michael Ingrisch Nabeel Mansour Marcus Unterrainer Lucie Heinzerling Jens Ricke Wolfgang G. Kunz |
| author_facet | Sebastian Mönch Maurice M. Heimer Michael Winkelmann Anne Guertler Max Schlaak Amanda Tufman Najib Ben Khaled Enrico de Toni Christoph B. Westphalen Michael von Bergwelt-Baildon Julien Dinkel Philipp M. Kazmierczak Michael Ingrisch Nabeel Mansour Marcus Unterrainer Lucie Heinzerling Jens Ricke Wolfgang G. Kunz |
| author_sort | Sebastian Mönch |
| collection | DOAJ |
| description | Abstract Background Pseudoprogression (PsPD) is a rare response pattern to immune checkpoint inhibitor (ICI) therapy in oncology. This study aims to reveal imaging features of PsPD, and their association to other relevant findings. Methods Patients with PsPD who had at least three consecutive cross-sectional imaging studies at our comprehensive cancer center were retrospectively analyzed. Treatment response was assessed according to immune Response Evaluation Criteria in Solid Tumors (iRECIST). PsPD was defined as the occurrence of immune unconfirmed progressive disease (iUPD) without follow-up confirmation. Target lesions (TL), non-target lesions (NTL), new lesions (NL) were analyzed over time. Tumor markers and immune-related adverse events (irAE) were correlated. Results Thirty-two patients were included (mean age: 66.7 ± 13.6 years, 21.9% female) with mean baseline STL of 69.7 mm ± 55.6 mm. PsPD was observed in twenty-six patients (81.3%) at FU1, and no cases occurred after FU4. Patients with iUPD exhibited the following: TL increase in twelve patients, (37.5%), NTL increase in seven patients (21.9%), NL appearance in six patients (18.8%), and combinations thereof in four patients (12.5%). The mean and maximum increase for first iUPD in sum of TL was 19.8 and 96.8 mm (+ 700.8%). The mean and maximum decrease in sum of TL between iUPD and consecutive follow-up was − 19.1 mm and − 114.8 mm (-60.9%) respectively. The mean and maximum sum of new TL at first iUPD timepoint were 7.6 and 82.0 mm respectively. In two patients (10.5%), tumor-specific serologic markers were elevated at first iUPD, while the rest were stable or decreased among the other PsPD cases (89.5%). In fourteen patients (43.8%), irAE were observed. Conclusions PsPD occurred most frequently at FU1 after initiation of ICI treatment. The two most prevalent reasons for PsPD were TL und NTL progression, with an increase in TL diameter commonly below + 100%. In few cases, PsPD was observed even if tumor markers were rising compared to baseline. Our findings also suggest a correlation between PsPD and irAE. These findings may guide decision-making of ICI continuation in suspected PsPD. |
| first_indexed | 2024-03-13T06:08:08Z |
| format | Article |
| id | doaj.art-2c2fcfaf0c564e3e9f88c328dca83c52 |
| institution | Directory Open Access Journal |
| issn | 1470-7330 |
| language | English |
| last_indexed | 2024-03-13T06:08:08Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Cancer Imaging |
| spelling | doaj.art-2c2fcfaf0c564e3e9f88c328dca83c522023-06-11T11:24:14ZengBMCCancer Imaging1470-73302023-06-0123111010.1186/s40644-023-00580-9Patterns of pseudoprogression across different cancer entities treated with immune checkpoint inhibitorsSebastian Mönch0Maurice M. Heimer1Michael Winkelmann2Anne Guertler3Max Schlaak4Amanda Tufman5Najib Ben Khaled6Enrico de Toni7Christoph B. Westphalen8Michael von Bergwelt-Baildon9Julien Dinkel10Philipp M. Kazmierczak11Michael Ingrisch12Nabeel Mansour13Marcus Unterrainer14Lucie Heinzerling15Jens Ricke16Wolfgang G. Kunz17Department of Radiology, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Dermatology and Allergy, University Hospital, LMU MunichDepartment of Dermatology and Allergy, University Hospital, LMU MunichDepartment of Medicine V, University Hospital, LMU MunichDepartment of Medicine II, University Hospital, LMU MunichDepartment of Medicine II, University Hospital, LMU MunichDepartment of Medicine III, University Hospital, LMU MunichDepartment of Medicine III, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Dermatology and Allergy, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichDepartment of Radiology, University Hospital, LMU MunichAbstract Background Pseudoprogression (PsPD) is a rare response pattern to immune checkpoint inhibitor (ICI) therapy in oncology. This study aims to reveal imaging features of PsPD, and their association to other relevant findings. Methods Patients with PsPD who had at least three consecutive cross-sectional imaging studies at our comprehensive cancer center were retrospectively analyzed. Treatment response was assessed according to immune Response Evaluation Criteria in Solid Tumors (iRECIST). PsPD was defined as the occurrence of immune unconfirmed progressive disease (iUPD) without follow-up confirmation. Target lesions (TL), non-target lesions (NTL), new lesions (NL) were analyzed over time. Tumor markers and immune-related adverse events (irAE) were correlated. Results Thirty-two patients were included (mean age: 66.7 ± 13.6 years, 21.9% female) with mean baseline STL of 69.7 mm ± 55.6 mm. PsPD was observed in twenty-six patients (81.3%) at FU1, and no cases occurred after FU4. Patients with iUPD exhibited the following: TL increase in twelve patients, (37.5%), NTL increase in seven patients (21.9%), NL appearance in six patients (18.8%), and combinations thereof in four patients (12.5%). The mean and maximum increase for first iUPD in sum of TL was 19.8 and 96.8 mm (+ 700.8%). The mean and maximum decrease in sum of TL between iUPD and consecutive follow-up was − 19.1 mm and − 114.8 mm (-60.9%) respectively. The mean and maximum sum of new TL at first iUPD timepoint were 7.6 and 82.0 mm respectively. In two patients (10.5%), tumor-specific serologic markers were elevated at first iUPD, while the rest were stable or decreased among the other PsPD cases (89.5%). In fourteen patients (43.8%), irAE were observed. Conclusions PsPD occurred most frequently at FU1 after initiation of ICI treatment. The two most prevalent reasons for PsPD were TL und NTL progression, with an increase in TL diameter commonly below + 100%. In few cases, PsPD was observed even if tumor markers were rising compared to baseline. Our findings also suggest a correlation between PsPD and irAE. These findings may guide decision-making of ICI continuation in suspected PsPD.https://doi.org/10.1186/s40644-023-00580-9Immune Checkpoint inhibitorsPseudoprogressionCancerAtypical response patternsImmune related adverse events |
| spellingShingle | Sebastian Mönch Maurice M. Heimer Michael Winkelmann Anne Guertler Max Schlaak Amanda Tufman Najib Ben Khaled Enrico de Toni Christoph B. Westphalen Michael von Bergwelt-Baildon Julien Dinkel Philipp M. Kazmierczak Michael Ingrisch Nabeel Mansour Marcus Unterrainer Lucie Heinzerling Jens Ricke Wolfgang G. Kunz Patterns of pseudoprogression across different cancer entities treated with immune checkpoint inhibitors Cancer Imaging Immune Checkpoint inhibitors Pseudoprogression Cancer Atypical response patterns Immune related adverse events |
| title | Patterns of pseudoprogression across different cancer entities treated with immune checkpoint inhibitors |
| title_full | Patterns of pseudoprogression across different cancer entities treated with immune checkpoint inhibitors |
| title_fullStr | Patterns of pseudoprogression across different cancer entities treated with immune checkpoint inhibitors |
| title_full_unstemmed | Patterns of pseudoprogression across different cancer entities treated with immune checkpoint inhibitors |
| title_short | Patterns of pseudoprogression across different cancer entities treated with immune checkpoint inhibitors |
| title_sort | patterns of pseudoprogression across different cancer entities treated with immune checkpoint inhibitors |
| topic | Immune Checkpoint inhibitors Pseudoprogression Cancer Atypical response patterns Immune related adverse events |
| url | https://doi.org/10.1186/s40644-023-00580-9 |
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