Patterns of response in metastatic NSCLC during PD-1 or PD-L1 inhibitor therapy: Comparison of the RECIST 1.1 and iRECIST criteria
Patterns of response in metastatic NSCLC during PD-1 or PD-L1 inhibitor therapy: Comparison of the RECIST 1.1 and iRECIST criteria
复制标题
PD-1 或 PD-L1 抑制剂治疗期间转移性 NSCLC 的反应模式：RECIST 1.1 和 iRECIST 标准的比较
DOI：
10.1111/1759-7714.13367
复制
发表时间：
2020-04-01
期刊：
影响因子：
2.9
通讯作者：
Zhao, Jing
中科院分区：
文献类型：
--
作者：
Liang, Hongge;Xu, Yan;Zhao, Jing
背景免疫治疗在晚期非小细胞肺癌（NSCLC）中起着重要作用。然而，由于免疫治疗的潜在炎症效应，放射学评估具有挑战性，这可能导致非典型的反应模式。识别这些非典型反应是至关重要的，使治疗决策和precipitation.Methods我们进行了回顾性分析，连续晚期非小细胞肺癌患者接受免疫治疗（单独或联合）。我们收集了患者的临床和病理数据，根据RECIST 1.1标准分析了疾病进展（PD）后继续免疫治疗的患者比例，并比较了RECIST 1.1和iRECIST标准之间的反应模式差异。结果共纳入了2018年1月至2019年4月在中国北京协和医学院治疗的43例患者。在10例（33.3%，10/30）患者中观察到超过根据RECIST 1.1的PD的持续免疫治疗，其中RECIST 1.1和iRECIST之间存在不一致的评估（30%，3/10），根据RECIST 1.1评估为PD，根据iRECIST评估为免疫未证实的PD。在7例免疫证实的PD患者中，1例（1/30，3.3%）出现假进展。PD后继续免疫治疗的患者（n = 10）与PD后未继续免疫治疗的患者（n = 20）相比，总生存期显著延长（未达到vs. 8.1个月：风险比，2.8; 95%置信区间：2.7-13.6，P = 0.03）。需要进一步的研究来优化iRECIST，并建立一些标准来选择根据RECIST 1.1在PD后继续免疫治疗获益的患者。
Background Immunotherapy plays an important role in advanced non-small cell lung cancer (NSCLC). However, radiological evaluation is challenging due to the potential inflammatory effects of immunotherapy, which can lead to atypical response patterns. Identifying these atypical responses is critical to making treatment decisions and prognostication.Methods We performed a retrospective analysis of consecutive advanced NSCLC patients treated with immunotherapy (alone or in combination). We collected patients' clinical and pathological data, analyzed the proportion of patients who continued immunotherapy beyond progressive disease (PD) per RECIST 1.1, and compared the differences in response patterns between the RECIST 1.1 and iRECIST criteria.Results A total of 43 patients treated at the Peking Union Medical College, China from January 2018 to April 2019 were included. Continued immunotherapy beyond PD per RECIST 1.1 was observed in 10 (33.3%, 10/30) patients, of which there were discordant assessments (30%, 3/10) between the RECIST 1.1 and iRECIST, which were evaluated as PD by RECIST 1.1 and immune unconfirmed PD by iRECIST. Among seven patients with immune confirmed PD, one (1/30, 3.3%) had pseudoprogression. Patients who continued immunotherapy beyond PD (n = 10) experienced significantly prolonged overall survival (not reached vs. 8.1 months: hazard ratio, 2.8; 95% confidence interval: 2.7-13.6, P = 0.03) compared with patients who did not continue immunotherapy beyond PD (n = 20).Conclusions RECIST 1.1 evaluation underestimated the benefit of immunotherapy. Further research is required to optimize iRECIST and establish some criteria for selecting patients who will benefit from continued immunotherapy beyond PD per RECIST 1.1.