Ultrasonographic findings can identify "pseudoprogression' under nivolumab therapy
Ultrasonographic findings can identify "pseudoprogression' under nivolumab therapy
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DOI：
10.1111/bjd.15198
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发表时间：
2017-12-01
影响因子：
10.3
通讯作者：
Shimizu, H.
中科院分区：
文献类型：
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作者：
Imafuku, K.;Hata, H.;Shimizu, H.
“假性进展”通常见于接受免疫检查点抑制剂（如nivolumab或ipilimumab）治疗的黑色素瘤患者。我们有时通过影像学检查，如计算机断层扫描（CT）或正电子发射断层扫描-CT来评估转移性病变。“假性进展”通常发生在初次给药时，这可能使医生难以确定疾病状况。在我们的两例用nivolumab（抗程序性细胞死亡-1抗体）治疗的转移性黑色素瘤病例中，我们检查了可以从体表进入的靶病变的超声检查（US），例如区域淋巴结或皮下转移。在这两种情况下，US显示在纳武利尤单抗给药40-50天后，病变的大小增加了约10%，尽管肿瘤内的血流在50天内减少了约20%。从US检测到血流减少后约100天开始，肿瘤大小开始减小。然而，对比CT无法检测肿瘤大小和肿瘤血流之间的关联。目前的病例表明，US可能是一种强有力的工具，用于区分接受癌症免疫治疗（如涉及免疫检查点抑制剂的治疗）的患者的"假进展“和真实的进展性疾病。进展性疾病的误诊可能导致对当前治疗的不必要的改变。因此，我们研究中的美国发现对医生来说可能具有临床实用性和教育意义。关于这个话题我们已经知道些什么？纳武单抗对不可切除的恶性黑色素瘤有效。然而，纳武单抗治疗靶向的病变有时会在治疗的初始阶段扩大，这种现象称为“假进展”。区分假进展和实际进展性疾病是困难但重要的。到目前为止，还没有报道指出在疑似假进展的情况下确定转移性肿瘤内血流的诊断挑战。这项研究增加了什么？观察到一种现象，其中最初在尺寸上发展的转移性病变随后通过超声检查（US）发现血流明显减少，随后肿瘤尺寸减小。使用计算机断层扫描很难识别内部转移病灶。因此，使用超声评估肿瘤的血流可能有助于区分假性进展和真正的进展性疾病。英国皮肤病学杂志2017; 177：1483-1484。
Pseudoprogression' is often seen in patients with melanomas who are treated with immune checkpoint inhibitors such as nivolumab or ipilimumab. We sometimes evaluate metastatic lesions by imaging tests such as computed tomography (CT) or positron emission tomography-CT. Pseudoprogression' usually occurs upon the initial administration, which may make it difficult for the physician to determine the disease condition. In our two cases of metastatic melanoma treated with nivolumab (antiprogrammed cell death-1 antibody), we examined the ultrasonography (US) of target lesions that could be accessed from the body surface, such as those of the regional lymph node or subcutaneous metastasis. In both cases, the US revealed a lesion approximately 10% greater in size after 40-50 days of nivolumab administration, even though the blood flow inside the tumour was reduced by about 20% within 50 days. From about 100 days after blood flow reduction was detected by US, the tumours began to decrease in size. However, contrast CT was unable to detect the association between tumour size and tumour blood flow. The present cases suggest that US could be a powerful tool for differentiating between pseudoprogression' and real progressive disease in patients treated with cancer immunotherapies such as those involving immune checkpoint inhibitors. The misdiagnosis of progressive disease can lead to unnecessary alterations to the current treatment. Therefore, the US findings in our study could be clinically useful and educational for physicians.What's already known about this topic?Nivolumab is effective for unresectable malignant melanoma. However, a lesion targeted with nivolumab therapy will sometimes enlarge in the initial phase of treatment, a phenomenon known as pseudoprogression'. It is difficult but important to differentiate pseudoprogression from actual progressive disease. To date, no reports have addressed the diagnostic challenge of determining blood flow inside metastatic tumours in cases of suspected pseudoprogression.What does this study add?A phenomenon was observed in which metastatic lesions that initially developed in size were subsequently found by ultrasonography (US) to have clear decreases in blood flow followed by decrease in tumour size. It was difficult to identify internal metastatic lesions using computed tomography. Therefore, the evaluation of blood flow of the tumour using US could be useful in differentiating pseudoprogression from true progressive disease.Linked Comment: Akiyama. Br J Dermatol 2017; 177:1483-1484.