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Pseudo- or real progression? An ovarian cancer patient under nivolumab: A case report

Mona Passler1, Eliane T Taube2, Jalid Sehouli3

  • 1Department of Gynecology, Competence Center for Ovarian Cancer (EKZE), Charité - University Medicine, Berlin 13353, Germany. mona.passler@charite.de.

World Journal of Clinical Oncology
|August 10, 2019
PubMed
Abstract

Insights

Checkpoint inhibitors like nivolumab can cause pseudoprogression in ovarian cancer patients, mimicking tumor growth. Early recognition is crucial for distinguishing this temporary phenomenon from actual disease progression.

Area of Science:

  • Oncology
  • Immunotherapy

Background:

  • Checkpoint inhibitors, such as anti-programmed death-1 antibodies (nivolumab), have transformed cancer treatment.
  • Initial successes in melanoma and renal cell carcinoma have extended to ovarian cancer.
  • Pseudoprogression, characterized by temporary tumor enlargement due to inflammation, is a recognized phenomenon with these agents.

Observation:

  • A case of platinum-resistant ovarian cancer treated with off-label nivolumab is presented.
  • The patient exhibited classic pseudoprogression, including inguinal lymph node swelling, after two cycles.
  • Rectal bleeding and new tumor infiltration led to a diagnosis of progressive disease after six cycles.

Findings:

  • Nivolumab treatment in ovarian cancer can induce pseudoprogression.
  • Distinguishing pseudoprogression from true disease progression is critical for patient management.
  • This phenomenon involves inflammatory cell infiltration and edema, leading to transient tumor size increase.

Implications:

  • Clinicians must be aware of pseudoprogression in ovarian cancer patients receiving immunotherapy.
  • Understanding the mechanisms of pseudoprogression aids in differentiating it from actual tumor progression.
  • Strategies for accurate assessment are essential for optimal treatment decisions in ovarian cancer.
Keywords:
Case reportCheckpoint inhibitionClinical oncologyGynecologic oncologyImmunooncologyNivolumabPseudoprogression

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