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J Thorac Oncol. 2018 May 5. pii: S1556-0864(18)30536-7. doi: 10.1016/j.jtho.2018.04.010. [Epub ahead of print]

Radiologic pseudoprogression during anti-PD1 therapy for advanced non-small cell lung cancer.

Author information

1
Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: sharyn.katz@uphs.upenn.edu.
2
Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Radiology, Brigham and Women's Hospital, Boston, MA.
3
Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
4
Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
5
Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD.

Abstract

INTRODUCTION:

Anti-PD1 (programmed cell death protein 1) therapy can lead to unconventional tumor responses including radiologic pseudoprogression. Here we determine the real-world incidence of radiologic pseudoprogression in advanced non-small cell lung cancer (NSCLC) and compare radiologic response criteria for disease response assessment.

METHODS:

Electronic medical records of all NSCLC patients receiving anti-PD1 therapy at our institution over a 3-year period were retrospectively reviewed and patients with clinically suspected radiologic pseudoprogression identified. Patients without available follow-up imaging or clinical data were excluded. Imaging examinations were then analyzed to determine if progression was confirmed on subsequent re-imaging. Tumor response assessment by the RECIST1.1, unidimensional immune-related response criteria (iRRC) and iRECIST criteria for all patients were calculated and compared.

RESULTS:

A total of 228 consecutive patients were started on anti-PD1 therapy over a 3-year period, of which a total of 166 were evaluable, the majority (80%) of which received nivolumab. Fifteen patients (9%) were clinically suspected to have radiologic pseudoprogression due to tumor enlargement and/or development of new lesions on CT during the first 4-6 weeks of therapy and were maintained on anti-PD1 therapy. Of these patients, 3 patients (2% of all patients) demonstrated evidence of radiologic pseudoprogression at 1st re-imaging. iRRC and iRECIST were more accurate in classifying radiologic pseudoprogression as non-progression; none of the 3 cases were deemed progression by iRRC or iRECIST, compared to all 3 cases called progression on RECIST1.1.

CONCLUSIONS:

Radiologic pseudoprogression is a clinical challenge but an uncommon occurrence in NSCLC patients receiving anti-PD1 therapy.

PMID:
29738824
DOI:
10.1016/j.jtho.2018.04.010

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