CLO19-026: Determining the Treatment Decision of Tumors With Mixed Response
CLO19-026: Determining the Treatment Decision of Tumors With Mixed Response
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CLO19-026：确定具有混合反应的肿瘤的治疗决策
DOI：
10.6004/jnccn.2018.7244
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发表时间：
2019
影响因子：
13.4
通讯作者：
M. Menefee
中科院分区：
文献类型：
--
作者：
Candice Baldeo;T. Kaleem;R. Paz;J. Copland;M. Menefee
简介：接受全身抗癌治疗的晚期实体瘤患者通常会接受影像学研究以评估治疗效果。对癌症治疗的混合反应（MR）是一种常见但很少描述的现象。关于这种临床困境的发生率和可能机制的数据很少。潜在的病因包括肿瘤异质性、肿瘤微环境的差异以及不同肿瘤沉积物的药物递送差异。 MR 也有可能只是反映了耐药性出现率的差异。 MR 代表了临床医生的治疗困境。方法：混合肿瘤反应定义为： 一个肿瘤尺寸减小；一个肿瘤尺寸增大（分类为 RECIST 缓解/进展），一个肿瘤稳定；另一个肿瘤进展，一个肿瘤稳定；另一个肿瘤有反应，新肿瘤；另一个肿瘤有反应或保持稳定。 2015 年至 2017 年间，对 120 例重新分期 CT 扫描进行了回顾，这些患者接受了至少 1 种晚期癌症诊断治疗，并显示 MR；排除血液系统恶性肿瘤。审查图表以确定 MR 时做出的临床决定。结果：对各种实体瘤诊断总共 120 次 MR 扫描进行了回顾。 38 例扫描因失访或死亡而被排除。在剩余的 82 例扫描中，30 例更换了治疗，50 例继续相同的治疗，2 例在当前治疗中添加了额外的药物（表）。在转换治疗的患者中，20% (6/30) 在接下来的扫描中显示出对治疗的反应。在继续当前治疗的病例中，6-8周后进行的重新分期扫描没有显示出反应。在下一次扫描之前更换治疗的组中有 4 例 (10%) 死亡，而在下一次扫描之前治疗保持不变的组中有 5 例 (10%) 死亡。结论：无论治疗决策如何，MR 均与不良预后相关。这些数据是回顾性的，而且我们的样本量很小，因此无法得出明确的结论。然而，观察到 MR 时改变治疗可能对某些患者有益。有必要进行前瞻性评估，以更准确地描述和理解 MR 现象。
Introduction: Individuals receiving systemic anticancer therapies for advanced solid tumors routinely undergo imaging studies to assess the efficacy of the treatment. Mixed response (MR) to cancer therapy is a common but poorly described phenomenon. There is a paucity of data regarding both the incidence and possible mechanisms of this clinical quandary. Potential etiologies include tumor heterogeneity, differences in tumor microenvironment, and discrepancies in drug delivery to different tumor deposits. It is also possible that MR simply reflects differences in the rate of resistance emerging. MR represents a therapeutic dilemma for the clinician. Methods: Mixed tumor response was defined as: One tumor decreasing in size; one tumor increasing in size (classified as RECIST response/progressions), One tumor stable; another tumor progressing, One tumor stable; another tumor responding, New tumor; another tumor responding or remaining stable. Between 2015 and 2017, 120 restaging CT scans were reviewed of patients who had received at least 1 line of therapy for advanced cancer diagnosis which showed MR; hematologic malignancies were excluded. Charts were reviewed to determine the clinical decision that was made at the time of the MR. Results: A total of 120 scans with MR were reviewed from various solid tumor diagnoses. 38 scans were excluded due to loss of follow-up or death. Of the remaining 82 scans, therapy was switched in 30, the same therapy was continued in 50, and an additional agent was added to the current treatment in 2 cases (Table). Of the patients in which treatment was switched, 20% (6/30) showed response to treatment on the following scan. Of the cases that were kept on current treatment, none showed response on the following restaging scan which was done 6–8 weeks later. There were 4 (10%) deaths prior to the next scan in the group that had treatment switched and similarly 5 deaths (10%) prior to the next scan in the group in which treatment remained the same. Conclusion: MR is associated with a poor prognosis, irrespective of treatment decisions. These data are retrospective and our sample size is small, so definitive conclusions cannot be drawn. However, changing therapy when a MR is observed may be of benefit to some patients. A prospective evaluation to more accurately describe and understand the MR phenomenon is warranted.