Patterns of responses in metastatic NSCLC during PD-1 or PDL-1 inhibitor therapy: Comparison of RECIST 1.1, irRECIST and iRECIST criteria

Tazdait, Mélodie; Mezquita, Laura; Lahmar, J.; Ferrara, Roberto; Bidault, François; Ammari, Samy; Balleyguier, Corinne; Planchard, David; Gazzah, Anas; Soria, Jean‐Charles; Marabelle, Aurélien; Besse, Benjamin; Caramella, Caroline

doi:10.1016/j.ejca.2017.10.017

Cited by 265 publications

(246 citation statements)

References 28 publications

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“…In previous reports, the proportion of patients with NSCLC who received continued immunotherapy beyond PD assessed using RECIST 1.1 ranged from 30%–90%, similar to our results. In clinical trials, the incidence of PsPD in NSCLC was 0.6–5.8% .…”

Section: Discussionsupporting

confidence: 91%

“…We defined progression‐free survival 1 (PFS1) as the time from initial immunotherapy to RECIST 1.1‐defined first progressive disease or death, progression‐free survival 2 (PFS2) as the time from RECIST 1.1‐defined first progressive disease to iRECIST‐defined first progressive disease or death, and immune‐related progression‐free survival (iPFS) as the first date at which progression criteria were met (i.e., the date of iUPD) provided that iCPD was confirmed at the next assessment. For patients with tumor progression evaluated per the RECIST 1.1, pseudoprogression (PsPD) was defined among patients who met the conventional response criteria for progressive disease but later showed reduced tumor burden …”

Section: Methodsmentioning

confidence: 99%

“…Immune checkpoint inhibitors stimulate the immune system to attack tumors instead of directly targeting tumor cells, leading to different patterns of response to immunotherapy . Due to the potential inflammatory effects of immunotherapy, tumors treated with immunotherapy might develop an atypical response pattern, wherein patients initially meet the criteria for progressive disease as per RECIST 1.1 but later show stable or reduced tumor burden . Discontinuation of immunotherapy due to disease progression as per RECIST 1.1 may lead to the underestimation of the efficacy of immunotherapy, leading to the premature stoppage of immunotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Patterns of response in metastatic NSCLC during PD‐1 or PD‐L1 inhibitor therapy: Comparison of the RECIST 1.1 and iRECIST criteria

Liang

Chen

et al. 2020

Thoracic Cancer

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Background Immunotherapy plays an important role in advanced non‐small cell lung cancer (NSCLC). However, radiological evaluation is challenging due to the potential inflammatory effects of immunotherapy, which can lead to atypical response patterns. Identifying these atypical responses is critical to making treatment decisions and prognostication. Methods We performed a retrospective analysis of consecutive advanced NSCLC patients treated with immunotherapy (alone or in combination). We collected patients' clinical and pathological data, analyzed the proportion of patients who continued immunotherapy beyond progressive disease (PD) per RECIST 1.1, and compared the differences in response patterns between the RECIST 1.1 and iRECIST criteria. Results A total of 43 patients treated at the Peking Union Medical College, China from January 2018 to April 2019 were included. Continued immunotherapy beyond PD per RECIST 1.1 was observed in 10 (33.3%, 10/30) patients, of which there were discordant assessments (30%, 3/10) between the RECIST 1.1 and iRECIST, which were evaluated as PD by RECIST 1.1 and immune unconfirmed PD by iRECIST. Among seven patients with immune confirmed PD, one (1/30, 3.3%) had pseudoprogression. Patients who continued immunotherapy beyond PD (n = 10) experienced significantly prolonged overall survival (not reached vs. 8.1 months: hazard ratio, 2.8; 95% confidence interval: 2.7–13.6, P = 0.03) compared with patients who did not continue immunotherapy beyond PD (n = 20). Conclusions RECIST 1.1 evaluation underestimated the benefit of immunotherapy. Further research is required to optimize iRECIST and establish some criteria for selecting patients who will benefit from continued immunotherapy beyond PD per RECIST 1.1.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patterns of response in metastatic NSCLC during PD‐1 or PD‐L1 inhibitor therapy: Comparison of the RECIST 1.1 and iRECIST criteria

Liang

Chen

et al. 2020

Thoracic Cancer

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“…Pseudoprogression in immunotherapy, where initial tumor growth is followed by regression, has been reported in 6.7–12% of melanoma patients . Another study reported that 13% of NSCLC patients experienced pseudoprogression during immunotherapy . The underlying mechanism was either continued tumor growth until a sufficient immune response occurred, or a transient immune‐cell infiltrate.…”

Section: Discussionmentioning

confidence: 99%

Well‐controlled pleural effusion indicated pseudoprogression after immunotherapy in lung cancer: A case report

Liu

Chen²,

Li³

et al. 2018

Thoracic Cancer

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Squamous cancer (SqCC) of the lung has a poor prognosis. With the advent of immunotherapy, prognosis has tended to improve; however, pseudoprogression poses a challenge to the management of immunotherapy. Herein, we discuss the case of a 47‐year‐old heavy smoker with advanced SqCC. The patient had recurrent disease after initial successful control of the tumor by concurrent radiochemotherapy, together with ample pleural effusion. Pleural effusion was well controlled with systematic nivolumab and intra‐thoracic recombinant endostatin; however with simultaneous deterioration of performance and tumor progression. Nivolumab was maintained with the addition of nab‐paclitaxel. The combination soon led to a partial response and rapid improvement of the patient's performance. During treatment of this case, we advocated the early control of pleural effusion as an indicator for pseudoprogression. Our experience might be helpful to identify pseudoprogression for the clinical management of immunotherapy.

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“…Dissociated response, namely, mixed response, refers to concomitant shrinkage of some lesions and flare‐up of others, indicating disparate responses across different organs (Figure ) . In a recent study of 160 NSCLC patients treated with anti‐PD‐1/PD‐L1 therapy, dissociated responses were observed in 12 patients (7.5%); of whom six (50%) patients obtained clinical benefit, whereas the remaining patients presented with tumor progression .…”

Section: The Role Of Medical Imaging In Immunotherapy: Response Assesmentioning

confidence: 99%

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

2019

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Immune checkpoint blockade (ICB) represents a promising approach in cancer therapy. Owing to the peculiar biologic mechanisms of anticancer activity, checkpoint blockers are accompanied with distinctive response patterns and toxicity profiles. Medical imaging is the cornerstone for response assessment to immunotherapy and plays a critical role in monitoring of immune‐related adverse events (irAEs). Imaging‐based biomarkers have shown tremendous potential for the prediction of therapeutic efficacies and clinical outcomes in patients treated with checkpoint inhibitors. In this article, the landscape of current response assessment systems for immunotherapy was reviewed with a special focus on the latest advances in the assessment of responses to ICB. Emerging imaging biomarkers were discussed along with the challenges regarding their clinical transformation. In addition, the biological mechanisms and clinical applications of ICB and irAEs were also within the scope of this review.

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Patterns of responses in metastatic NSCLC during PD-1 or PDL-1 inhibitor therapy: Comparison of RECIST 1.1, irRECIST and iRECIST criteria

Cited by 265 publications

References 28 publications

Patterns of response in metastatic NSCLC during PD‐1 or PD‐L1 inhibitor therapy: Comparison of the RECIST 1.1 and iRECIST criteria

Patterns of response in metastatic NSCLC during PD‐1 or PD‐L1 inhibitor therapy: Comparison of the RECIST 1.1 and iRECIST criteria

Well‐controlled pleural effusion indicated pseudoprogression after immunotherapy in lung cancer: A case report

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

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