Immunotherapy response assessment in neuro-oncology: a report of the RANO working group.
Immunotherapy response assessment in neuro-oncology: a report of the RANO working group.
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DOI：
10.1016/s1470-2045(15)00088-1
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发表时间：
2015-11
期刊：
影响因子：
--
通讯作者：
Reardon DA
中科院分区：
文献类型：
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作者：
Okada H;Weller M;Huang R;Finocchiaro G;Gilbert MR;Wick W;Ellingson BM;Hashimoto N;Pollack IF;Brandes AA;Franceschi E;Herold-Mende C;Nayak L;Panigrahy A;Pope WB;Prins R;Sampson JH;Wen PY;Reardon DA
免疫治疗在神经肿瘤患者中是一个很有前途的治疗领域。然而，早期研究揭示了与评估反映延迟反应或治疗引起的炎症的放射学变化相关的独特挑战。临床益处，包括长期存活和肿瘤消退，仍然可以发生在新病变最初明显进展或出现后。因此，完善接受免疫治疗的神经肿瘤患者的反应评估标准是必要的。一个由神经肿瘤学免疫治疗专家组成的多国多学科小组描述了神经肿瘤学免疫治疗反应评估(RANO)标准，该标准基于免疫相关反应标准(IRRC)和神经肿瘤学反应评估(RANO)工作组概述的确定肿瘤进展的指南。在启动免疫治疗后6个月内发现符合RANO标准的进展性疾病(PD)的患者中，如果患者的临床情况没有明显恶化，建议在后续的成像中确认放射学进展。拟议的标准还包括使用皮质类固醇的指南。综述了先进成像技术的作用和临床受益终点的测量，包括神经学和免疫学功能。随着神经肿瘤学免疫治疗试验经验的进一步积累，本文提出的伊朗指南将陆续演变，以提高其实用性。
Immunotherapy represents a promising area of therapy among neuro-oncology patients. However, early phase studies reveal unique challenges associated with assessment of radiological changes reflecting delayed responses or therapy-induced inflammation. Clinical benefit, including long-term survival and tumor regression, can still occur following initial apparent progression or appearance of new lesions. Refinement of response assessment criteria for neuro-oncology patients undergoing immunotherapy is therefore warranted. A multinational and multidisciplinary panel of neuro-oncology immunotherapy experts describes immunotherapy response assessment for neuro-oncology (iRANO) criteria that are based on guidance for determination of tumor progression outlined by the immune-related response criteria (irRC) and the response assessment in neuro-oncology (RANO) working group. Among patients who demonstrate imaging findings meeting RANO criteria for progressive disease (PD) within six months of initiating immunotherapy including the development of new lesions, confirmation of radiographic progression on follow-up imaging is recommended provided that the patient is not significantly worse clinically. The proposed criteria also include guidelines for use of corticosteroids. The role of advanced imaging techniques and measurement of clinical benefit endpoints including neurologic and immunologic functions are reviewed. The iRANO guidelines put forth herein will evolve successively to improve their utility as further experience from immunotherapy trials in neuro-oncology accumulate.