Immune RECIST criteria and symptomatic pseudoprogression in non-small cell lung cancer patients treated with immunotherapy

Abstract

BackgroundUncommon response during immunotherapy is a new challenging issue in oncology practice. Recently, new criteria for evaluation of response to immunotherapy immune response evaluation criteria in solid tumors (iRECIST) were accepted. According to iRECIST, worsening of performance status (PS) accompanied to pseudoprogression reflects most probably the true progression of the malignant disease.MethodsA systematic review of the literature was made by using several electronic database with the following search criteria: symptomatic pseudoprogression, atypical response, immunotherapy and lung cancer.ResultsIn the literature, we identified five reports of seven patients treated with immunotherapy that met the inclusion criteria. We also report our experience of patient with pseudoprogression and almost complete response after one dose of immunotherapy.ConclusionsAs seen from our review, iRECIST criteria might be insufficient in distinguishing true progression from pseudoprogression in some patients with advanced NSCLC treated with immunotherapy. More precise assessment methods are urgently needed.

Retrospective analysis of treatment-naive Slovenian patients with metastatic melanoma treated with pembrolizumab – real-world experience

“…One of them is pseudoprogression, which is described as a radiological progression that is followed by stabilization or response on the next imaging. 18 In Keynote-001 trial, the incidence of tumour pseudoprogression was 7.3%. 19 In our analysis, we did not collect data on this atypical response, therefore its influence on the response rate cannot be established.…”

Quantitative PET imaging of PD-L1 expression in xenograft and syngeneic tumour models using a site-specifically labelled PD-L1 antibody

“…Moreover, responding patients with PD-L1 negative tumours as well as non-responding patients with PD-L1 positive tumours have been reported during the course of anti-PD-L1 therapy [5,6]. Adding to this, assessing responses to immunotherapy by standard RECIST criteria may be challenging compared with conventional chemotherapy as tumour cells are not killed directly and the fact that pseudo progression often is observed in patients receiving immune checkpoint inhibitors [7][8][9].…”

Role of medical imaging for immune checkpoint blockade therapy: From response assessment to prognosis prediction

“…However, a recent review by Vrankar et al reported the "symptomatic pseudoprogression" in eight NSCLC patients treated with anti-PD-1/PD-L1 therapy. 42 These eight patients experienced psuedoprogression accompanied with clinical deterioration, followed by clinical benefit after 4-20 weeks after treatment onset. According to iRECIST, treatment beyond progression per RECIST 1.1 should only be allowed in patients with a stable clinical status.…”

“…Immune RECIST might fail to capture pseudoprogression, particularly in patients with “symptomatic pseudoprogression.” In general, pseudoprogression should not be accompanied with the deterioration of clinical status, which usually indicates the true progression. However, a recent review by Vrankar et al reported the “symptomatic pseudoprogression” in eight NSCLC patients treated with anti‐PD‐1/PD‐L1 therapy . These eight patients experienced psuedoprogression accompanied with clinical deterioration, followed by clinical benefit after 4‐20 weeks after treatment onset.…”