Patterns of responses in metastatic NSCLC during PD-1 or PDL-1 inhibitor therapy: Comparison of RECIST 1.1, irRECIST and iRECIST criteria
Patterns of responses in metastatic NSCLC during PD-1 or PDL-1 inhibitor therapy: Comparison of RECIST 1.1, irRECIST and iRECIST criteria
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DOI：
10.1016/j.ejca.2017.10.017
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发表时间：
2018-01-01
影响因子：
8.4
通讯作者：
Caramella, C.
中科院分区：
文献类型：
--
作者：
Tazdait, M.;Mezquita, L.;Caramella, C.
背景：免疫检查点抑制剂是转移性非小细胞肺癌（NSCLC）治疗策略的重要工具；然而，由于非典型反应模式的出现，放射学评估具有挑战性。已经提出了一些评估标准，例如实体瘤反应评估标准 (RECIST) 1.1 版、免疫相关 RECIST (irRECIST) 和 iRECIST，但尚未在同质人群中进行系统比较。 患者和方法：我们对接受抗程序性细胞死亡 1 或抗程序性死亡配体 1 治疗的连续晚期 NSCLC 患者进行了单中心回顾性分析。反应模式和 RECIST 之间的不一致1.1，描述了 irRECIST 和 iRECIST 指南，并探讨了反应模式和临床结果的关联。结果：总体而言，纳入了 2013 年 2 月至 2016 年 10 月期间接受治疗的 160 名患者。在 20 名患者 (13%) 中观察到非典型反应，其中包括 8 名假性进展 (PsPD) (5%) 和 12 名分离性反应 (8%)。 20 名患者中有 13 名表现出临床获益。根据 RECIST 1.1，37 名患者 (23%) 表现出客观缓解或疾病稳定，123 名患者 (77%) 出现进展。 80 名进展患者可进行 irRECIST 和 iRECIST 评估：15 名患者接受了不同的评估；然而，仅发现了三个（3.8%）不匹配对治疗决策有理论上的影响。患有 PsPD 或分离反应的患者比真正进展的患者具有更高的总生存率。结论：免疫检查点抑制剂治疗下 13% 的 NSCLC 患者出现非典型反应（PsPD/分离反应）。根据生存分析，RECIST 1.1 评估低估了免疫检查点抑制剂对 11% 进展患者的益处。免疫相关 RECIST 和 iRECIST 识别了这些非常规反应，差异率为 3.8%。 (C) 2017 Elsevier Ltd. 保留所有权利。
Background: Immune checkpoint inhibitors are an important tool in the therapeutic strategy against metastatic non-small cell lung cancer (NSCLC); however, radiological evaluation is challenging due to the emergence of atypical patterns of responses. Several evaluation criteria have been proposed, such as the Response Evaluation Criteria in Solid Tumours (RECIST), version 1.1, immune-related RECIST (irRECIST) and iRECIST, but have not been systematically compared in a homogeneous population.Patients and methods: We conducted a monocentric retrospective analysis of consecutive advanced NSCLC patients treated with an antieprogrammed cell death-1 or anti-program death-ligand 1. Response patterns and the discordance between RECIST 1.1, irRECIST and iRECIST guidelines were described, and associations of response patterns and clinical outcome were explored.Results: Overall, 160 patients treated between February 2013 and October 2016 were included. Atypical responses were observed in 20 patients (13%), including eight pseudoprogressions (PsPDs) (5%) and 12 dissociated responses (8%). Thirteen of the 20 patients demonstrated clinical benefit. Per the RECIST 1.1, 37 patients (23%) showed an objective response or stable disease, and 123 patients (77%) exhibited progression. Eighty progressive patients were assessable for irRECIST and iRECIST: 15 patients were assessed differently; however, only three (3.8%) mismatches with a theoretical impact on the therapeutic decision were identified. Patients with PsPD or dissociated response had higher overall survival than patients with true progression.Conclusion: Atypical responses (PsPD/dissociated response) occurred in 13% of NSCLC patients under immune checkpoint inhibitors. Based on survival analyses, the RECIST 1.1 evaluation underestimated the benefit of immune checkpoint inhibitors in 11% of the progressive patients. Immune-related RECIST and iRECIST identified these unconventional responses, with a 3.8% discrepancy rate. (C) 2017 Elsevier Ltd. All rights reserved.