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Novel patterns of response under immunotherapy.

E Borcoman1, Y Kanjanapan2, S Champiat3

  • 1Department of Drug Development and Innovation (D3i), Institut Curie, Paris, Saint-Cloud, France.

Annals of Oncology : Official Journal of the European Society for Medical Oncology
|January 19, 2019
PubMed
Summary

Immunotherapy offers durable responses in some advanced cancers, but novel progression patterns like pseudoprogression and hyperprogression require careful management. Current criteria may not fully capture these unique immune-related response patterns.

Keywords:
durable responsehyperprogressionimmunotherapypseudoprogressionresponse assessmenttreatment beyond progression

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Area of Science:

  • Oncology
  • Immunotherapy
  • Cancer Research

Background:

  • Immunotherapy presents unique response and progression patterns distinct from conventional cancer treatments.
  • Durable responses, maintained long-term even after treatment cessation, are a significant breakthrough in advanced cancers.
  • However, a standardized definition for durable response and optimal treatment duration remains undefined.

Purpose of the Study:

  • To review novel patterns of response and progression observed with cancer immunotherapy.
  • To discuss the clinical implications of pseudoprogression, hyperprogression, and dissociated responses.
  • To evaluate existing criteria for assessing immunotherapy response and identify limitations.

Main Methods:

  • Literature review of studies reporting on immunotherapy response and progression patterns.
  • Analysis of reported rates and characteristics of pseudoprogression, hyperprogression, and dissociated responses.
  • Comparison of immune-specific criteria with traditional RECIST criteria for response assessment.

Main Results:

  • Pseudoprogression, observed in <10% of patients, involves initial progression followed by lesion regression.
  • Hyperprogression, occurring in 4-29% of cases, signifies rapid disease acceleration under immunotherapy.
  • Dissociated responses show mixed progression and regression across different lesions.
  • Existing immune-specific criteria primarily address pseudoprogression, not hyperprogression or dissociated responses.

Conclusions:

  • Immunotherapy can lead to durable responses but also presents complex progression patterns.
  • Careful patient selection is crucial for treatment beyond progression, especially considering pseudoprogression.
  • Hyperprogression necessitates treatment interruption, while dissociated responses may require combined local and systemic therapies.
  • RECIST criteria remain a practical method for assessing immunotherapy response in clinical practice, despite limitations in capturing all immune-related patterns.