Pseudoprogression in Previously Treated Patients with Non-Small Cell Lung Cancer Who Received Nivolumab Monotherapy
Pseudoprogression in Previously Treated Patients with Non-Small Cell Lung Cancer Who Received Nivolumab Monotherapy
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DOI：
10.1016/j.jtho.2018.10.167
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发表时间：
2019-03-01
影响因子：
20.4
通讯作者：
Hirai, Toyohiro
中科院分区：
文献类型：
--
作者：
Fujimoto, Daichi;Yoshioka, Hiroshige;Hirai, Toyohiro
引言：Nivolumab可有效治疗既往接受过治疗的晚期NSCLC患者。然而，其放射学评价是具有挑战性的，因为非典型的反应模式，如假进展。我们研究了既往接受过纳武利尤单抗治疗的NSCLC患者的特征和结局，这些患者经历了pseudoprogression.Methods的发展：我们对既往接受过纳武利尤单抗单药治疗的晚期NSCLC患者进行了一项15中心回顾性队列研究。对于显示假进展的患者，我们将无进展生存期1（PFS 1）定义为至实体瘤疗效评价标准定义的首次疾病进展的时间，将无进展生存期2（PFS 2）定义为至实体瘤疗效评价标准定义的第二次疾病进展或死亡的时间。在纳入的542例患者中，分别有20%和53%的患者表现出典型的缓解和进展。在14例（3%）显示假性进展的患者中，大多数（n = 10）在纳武单抗治疗3个月内显示出应答。中位PFS 1和PFS 2分别为1.0和7.3个月。假进展患者的PFS 2中位数显著短于典型缓解患者的PFS（p < 0.001）。相比之下，显示假进展的患者有显着更长的总生存期比显示典型进展的患者（p = 0.001）。结论：假进展是罕见的，和反应的持续时间在患者谁显示假进展是短于在患者谁显示了典型的反应。然而，假进展的生存获益明显优于典型进展。需要进一步的研究来阐明假进展的特征和机制。(C)2018年国际肺癌研究协会。爱思唯尔公司出版All rights reserved.
Introduction: Nivolumab is effective in the treatment of previously treated patients with advanced NSCLC. However, its radiological evaluation is challenging because of atypical patterns of response such as pseudoprogression. We examined the characteristics and outcomes of previously treated patients with NSCLC who were treated with nivolumab and experienced development of pseudoprogression.Methods: We conducted a 15-center retrospective cohort study of previously treated patients with advanced NSCLC who received nivolumab monotherapy. For the patients who showed pseudoprogression, we defined progression-free survival 1 (PFS1) as the time to Response Evaluation Criteria in Solid Tumors-defined first progressive disease and progression-free survival 2 (PFS2) as the time to Response Evaluation Criteria in Solid Tumors-defined second progressive disease or death.Results: Among the 542 patients included, 20% and 53% showed a typical response and progression, respectively. Of the 14 (3%) patients who showed pseudoprogression, most (n = 10) showed a response within 3 months of nivolumab treatment. The median PFS1 and PFS2 were 1.0 and 7.3 months, respectively. The median PFS2 was significantly shorter in the patients who showed pseudoprogression than the PFS of the patients with a typical response (p < 0.001). In contrast, patients showing pseudoprogression had significantly longer overall survival than did patients showing typical progression (p = 0.001).Conclusions: Pseudoprogression was uncommon, and the duration of response in patients who showed pseudoprogression was shorter than that in patients who showed a typical response. However, the survival benefit of pseudoprogression was markedly better than that of typical progression. Further research is required to elucidate the characteristics of and mechanisms underlying pseudoprogression. (C) 2018 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.