Keywords:
Lung, Oncology, CT, Chemotherapy, Radiation therapy / Oncology, Cancer, Monoclonal antibodies
Authors:
C. Moroni, D. Cozzi, M. Bartolucci, F. Giannelli, V. Bonti, V. Scotti, F. Mazzoni, V. Miele; Florence/IT
DOI:
10.26044/ecr2019/C-0980
Aims and objectives
Nowadays immunotherapy is widely used in oncology for different kind of primary tumous and it has the main effect to improve the immune system in identifying and fighting tumour cells.
Nivolumab is a PD-1 (Programme Death cell-1) check-point inhibitor that distrupts PD-1 mediated signalling and restores anti-tumour immunity.
Nivolumab is the only PD-1 inhibitor approved for a broad range of patients with previously treated metastatic Non Small Cell Lung Cancer (NSCLC,
stage IIIb-IV) regardless of PD-L1 expression [1,2].
Nivolumab,
like others Immune Check-Point Inhibitors,
may cause atypical CT-patterns of response compared to classical cytotoxic therapies,
including Pseudoprogression and Hyperprogression [3].
Pseudoprogression is an uncommon phenomenon with an incidence of 0.6-5% in NSCLC patients treated with immune check-point inhibitors [4,5].
It is defined as an increasing in size of pre-existing lesions,
or appearance of new ones,
immediately after starting immunotherapy,
followed by a decreasing in size of the total tumour burden (TTB).
Pseudoprogression is challenging for both radiologists and clinicians as,
at the moment, there isn't any radiological or biochemical marker able to discriminate between progression and pseudoprogression.
Although seen more frequently in the first weeks after treatment initiation,
Pseudoprogression can also appear months after [6].
In fact,
iRECIST criteria recommend a follow-up imaging at 4-8 weeks after first progression,
in order to evaluate if it is a real progression or not [7].
Hyperprogression is a severe progression of the disease and is defined as a rapid increase in tumour growth after initiation of immunotherapy (TTB > 50%).
Hyperprogression may not be as a rare phenomenon as previously thought (various incidence from 9-16%) and it is associated with a worse overall survival [8,9].
In general,
hyperprogression is more commonly seen in elderly patients (> 65 years old); no significant difference is seen,
thought,
between different tumor histology [10].
Purpose: the aim of this study is to compare the distribution in patient's age (> and < 65 years),
tumour stage (IIIb-IV) and histology (adenocarcinoma - squamous cell carcinoma) between three different groups of Nivolumab responders (patients with Hyperprogression,
patients with Pseudoprogression,
others responders (OR)) and to verify if there are significant differences between them.