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Tumor Pseudoprogression

Amer M Najjar, Jason M Johnson, Dawid Schellingerhout
Imaging plays a critical role in the management of the highly complex and widely diverse central nervous system (CNS) malignancies in providing an accurate diagnosis, treatment planning, response assessment, prognosis, and surveillance. Contrast-enhanced magnetic resonance imaging (MRI) is the primary modality for CNS disease management due to its high contrast resolution, reasonable spatial resolution, and relatively low cost and risk. However, defining tumor response to radiation treatment and chemotherapy by contrast-enhanced MRI is often difficult due to various factors that can influence contrast agent distribution and perfusion, such as edema, necrosis, vascular alterations, and inflammation, leading to pseudoprogression and pseudoresponse assessments...
November 28, 2018: Bioengineering
Leandro J C Oliveira, Aline B L Gongora, Felipe G Barbosa, Carlos H Dos Anjos, Rodrigo R Munhoz
Currently, there is no established standard of care for patients with metastatic CSCC. Based on the mechanisms of CSCC carcinogenesis has been postulated that these tumors may be amenable to PD-1/PD-L1 blockade.This case illustrates a patient with CSCC with nodal involvement and pulmonary metastases, refractory to two lines of platinum-based regimens and salvage surgery, for whom treatment with nivolumab was recommended. His clinical course was marked by an atypical pattern of response, with initial reduction of soft tissue/visceral lesions, yet development of new bone findings, followed by overall improvement in subsequent scans and sustained disease control upon treatment continuation...
November 27, 2018: Journal for Immunotherapy of Cancer
Daichi Fujimoto, Hiroshige Yoshioka, Yuki Kataoka, Takeshi Morimoto, Tae Hata, Young Hak Kim, Keisuke Tomii, Tadashi Ishida, Masataka Hirabayashi, Satoshi Hara, Manabu Ishitoko, Yasushi Fukuda, Moon Hee Hwang, Naoki Sakai, Motonari Fukui, Hitoshi Nakaji, Mitsunori Morita, Tadashi Mio, Takehiro Yasuda, Takakazu Sugita, Toyohiro Hirai
INTRODUCTION: Nivolumab is effective in the treatment of previously treated patients with advanced non-small cell lung cancer (NSCLC). However, its radiological evaluation is challenging because of atypical patterns of responses such as pseudoprogression. We examined the characteristics and outcomes of previously treated patients with NSCLC who were treated with nivolumab and who developed pseudoprogression. METHODS: We conducted a 15-center retrospective cohort study of previously treated patients with advanced NSCLC who received nivolumab monotherapy...
November 20, 2018: Journal of Thoracic Oncology
M Ismail, V Hill, V Statsevych, R Huang, P Prasanna, R Correa, G Singh, K Bera, N Beig, R Thawani, A Madabhushi, M Aahluwalia, P Tiwari
BACKGROUND AND PURPOSE: Differentiating pseudoprogression, a radiation-induced treatment effect, from tumor progression on imaging is a substantial challenge in glioblastoma management. Unfortunately, guidelines set by the Response Assessment in Neuro-Oncology criteria are based solely on bidirectional diametric measurements of enhancement observed on T1WI and T2WI/FLAIR scans. We hypothesized that quantitative 3D shape features of the enhancing lesion on T1WI, and T2WI/FLAIR hyperintensities (together called the lesion habitat) can more comprehensively capture pathophysiologic differences across pseudoprogression and tumor recurrence, not appreciable on diametric measurements alone...
November 1, 2018: AJNR. American Journal of Neuroradiology
Ingrid Digernes, Endre Grøvik, Line B Nilsen, Cathrine Saxhaug, Oliver Geier, Edmund Reitan, Dag Ottar Sætre, Birger Breivik, Timothy Reese, Kari Dolven Jacobsen, Åslaug Helland, Kyrre Eeg Emblem
Purpose: This study aimed to investigate the hemodynamic status of cerebral metastases prior to and after stereotactic radiation surgery (SRS) and to identify the vascular characteristics that are associated with the development of pseudoprogression from radiation-induced damage with and without a radionecrotic component. Methods and materials: Twenty-four patients with 29 metastases from non-small cell lung cancer or malignant melanoma received SRS with dose of 15 Gy to 25 Gy...
October 2018: Advances in Radiation Oncology
Martina Vrankar, Mojca Unk
Background Uncommon response during immunotherapy is a new challenging issue in oncology practice. Recently, new criteria for evaluation of response to immunotherapy immune response evaluation criteria in solid tumors (iRECIST) were accepted. According to iRECIST, worsening of performance status (PS) accompanied to pseudoprogression reflects most probably the true progression of the malignant disease. Methods A systematic review of the literature was made by using several electronic database with the following search criteria: symptomatic pseudoprogression, atypical response, immunotherapy and lung cancer...
October 18, 2018: Radiology and Oncology
Emily Hinchcliff, David Hong, Hung Le, Gary Chisholm, Revathy Iyer, Aung Naing, Patrick Hwu, Amir Jazaeri
OBJECTIVE: To describe the clinical outcomes associated with the use of checkpoint inhibitor therapy in recurrent ovarian malignancy. METHODS: Women with recurrent ovarian cancer treated with an immune checkpoint inhibitor between 1/2012 and 8/2017 were included. RECIST criteria determined disease status, and immune related adverse events (irAE) were graded per trial protocols. Predictors of response, irAE, progression free survival (PFS) and overall survival (OS) were investigated...
October 23, 2018: Gynecologic Oncology
S Foller, H Oppel-Heuchel, M-O Grimm
In contrast to chemotherapy, treatment with immune checkpoint inhibitors occasionally results in an unconventional pattern of response. Besides an early partial or complete response or tumor progression, a so-called pseudoprogression, a "mixed response" or late responses can also be observed. Treatment beyond radiographically defined progression may therefore be appropriate in selected cases. For these treatment decisions, the clinical evaluation of the patient (performance status, symptoms, etc...
November 2018: Der Urologe. Ausg. A
Masaki Kanazu, Ryuya Edahiro, Hiroyuki Krebe, Kohei Nishida, Mikako Ishijima, Takeshi Uenami, Yuki Akazawa, Yukihiro Yano, Toshihiko Yamaguchi, Masahide Mori
Nivolumab is an anti-PD-1 blocking monoclonal antibody approved for the treatment of non-small cell lung cancer (NSCLC). However, some patients on immunotherapy may experience rapid progression and worsening clinical status, known as hyperprogressive disease. We retrospectively reviewed the clinical records of patients with NSCLC administered nivolumab therapy at Toneyama National Hospital, Japan, from January 2016 to January 2018. Of the 87 patients administered nivolumab therapy, five experienced rapid progression during one cycle of nivolumab therapy...
October 17, 2018: Thoracic Cancer
Norikazu Matsuo, Koichi Azuma, Satoshi Hattori, Junya Ohtake, Akihiko Kawahara, Hidenobu Ishii, Takaaki Tokito, Kazuhiko Yamada, Yuji Shibata, Tadasuke Shimokawaji, Tetsuro Kondo, Terufumi Kato, Haruhiro Saito, Kouzo Yamada, Tetsuro Sasada, Tomoaki Hoshino
Although programmed death (PD)-1 immune checkpoint therapies target the immune system, the relationship between inflammatory factors and the clinical outcome of anti-PD-1 therapy for non-small cell lung cancer (NSCLC) is not fully understood. Here we examined the association between soluble immune mediators and the outcome of treatment with PD-1 inhibitors in patients with advanced/recurrent NSCLC. In two independent cohorts, we assessed the levels of 88 different soluble immune mediators in peripheral blood before and after anti-PD-1 treatment, and evaluated their associations with clinical outcomes...
October 11, 2018: International Journal of Cancer. Journal International du Cancer
Michael Esser, Cristopher Kloth, Wolfgang Maximilian Thaiss, Christian Philipp Reinert, Jan Fritz, Hans-Georg Kopp, Marius Horger
PURPOSE: To evaluate CT patterns and textural features of soft tissue sarcomas following trabectedin therapy as well as their suitability for predicting therapeutic response. MATERIAL AND METHODS: A total of 31 patients (18 female, 13 male; mean age, 58.0years; range, 38-79years) with sarcoma under trabectedin as a third-line therapy between October 2008 and July 2017 underwent baseline and follow-up contrast-enhanced CT. Response evaluation was based on modifiedCHOI-criteria and RECIST1...
October 2018: European Journal of Radiology
Brannan E O'Neill, Christian B Hochhalter, Christopher Carr, Michael J Strong, Marcus L Ware
Background: Central nervous system (CNS) tumors are a rare but devastating malignancy, often robbing patients of the basic quality of life. Despite advances in our understanding of the CNS tumor disease processes, the prognosis for patients with CNS tumors remains poor. Better characterization and diagnostic and monitoring approaches are necessary to assist in diagnosis and treatment of CNS tumors. One important tool in the neuro-oncology armamentarium is the use of advanced imaging techniques...
2018: Ochsner Journal
Michael J Wagner, Robert W Ricciotti, Jose Mantilla, Elizabeth T Loggers, Seth M Pollack, Lee D Cranmer
BACKGROUND: Chondrosarcoma is one of the most common malignant bone tumors in adults. Conventional chondrosarcoma represents around 85% of all chondrosarcomas and is notoriously difficult to treat with chemotherapy. CASE PRESENTATION: We describe a 67-year-old man with metastatic conventional chondrosarcoma who was treated with nivolumab. Treatment was discontinued after restaging showed increased tumor burden, which later proved to be pseudoprogression. The patient restarted nivolumab and continues to have a near complete response...
September 25, 2018: Journal for Immunotherapy of Cancer
Da Hyun Kang, Chaeuk Chung, Ju-Ock Kim, Sung Soo Jung, Hee Sun Park, Dong Il Park, Sun Young Jung, Myoungrin Park, Jeong Eun Lee
BACKGROUND: Immunotherapy is a new paradigm for the treatment of non-small-cell lung cancer (NSCLC), and targeting the PD-1 or PD-L1 pathway is a promising therapeutic option. Although PD-1/PD-L1 inhibitors are more effective than standard chemotherapy in lung cancer, clinicians are afraid to actively use them because of hyperprogression and pseudoprogression. The aim of this study was to investigate the factors associated with tumor response and serious outcomes. METHODS: We retrospectively collected the medical records of 51 patients with advanced NSCLC who received PD-1/PD-L1 inhibitors between January 2016 and February 2018...
November 2018: Thoracic Cancer
Takaya Ikeda, Hiroyuki Yamaguchi, Yosuke Dotsu, Hirokazu Taniguchi, Hiroshi Gyoutoku, Hiroaki Senju, Noriho Sakamoto, Satoshi Iwanaga, Yutaka Kuwatsuka, Minoru Fukuda, Hiroshi Mukae
Nivolumab, an anti-PD-1 antibody, has been shown to be effective in many cancers, such as malignant melanoma and lung cancer; however, nivolumab therapy can result in pseudoprogression. Diffuse alveolar hemorrhage (DAH) is persistent or recurrent pulmonary hemorrhage as a result of drugs, autoimmune diseases, or infections. DAH with pseudoprogression during nivolumab administration has rarely been reported. Herein, we describe our experience with one such case. A 41-year-old woman exhibited bloody sputum and ground glass opacities in the lungs along with tumor growth during nivolumab therapy for multiple lung metastases of malignant melanoma...
November 2018: Thoracic Cancer
Sara Elena Rebuzzi, Giacomo Bregni, Massimiliano Grassi, Azzurra Damiani, Michele Buscaglia, Sebastiano Buti, Giuseppe Fornarini
Immunotherapy is associated with different response patterns compared with chemotherapy and targeted therapy, including delayed response and stabilization after progression (pseudoprogression). According to new immuno-based response criteria, immunotherapy can be continued after radiological progression when a clinical benefit is observed. We report a case of an advanced renal cell carcinoma patient treated with nivolumab, who developed clinical benefit and delayed radiological response after initial progression...
September 2018: Immunotherapy
Edith Borcoman, Amara Nandikolla, Georgina Long, Sanjay Goel, Christophe Le Tourneau
Patterns of response and progression to immunotherapy may differ from those observed with drugs such as chemotherapy and molecularly targeted agents. Specifically, some patients experience a response after progression that is retrospectively named pseudoprogression. This phenomenon of pseudoprogression, first reported in patients with melanoma who were treated with ipilimumab, has led to the development of immune-specific related response criteria, such as irRC (immune-related response criteria), irRECIST (immune-related RECIST), and iRECIST (immunotherapy RECIST) that allow continued treatment beyond progression...
May 23, 2018: American Society of Clinical Oncology Educational Book
Vishwajith Sridharan, Rifaquat M Rahman, Raymond Y Huang, Nicole G Chau, Jochen H Lorch, Ravindra Uppaluri, Robert I Haddad, Glenn J Hanna, Jonathan D Schoenfeld
Radiologic predictors of response to immune checkpoint blockade (ICPi) in advanced head and neck squamous cell carcinoma (HNSCC) patients could help guide patient selection and management. We analyzed a large institutional cohort of 100 consecutive HNSCC patients treated with ICPi to investigate associations between molecular and radiologic phenotype and assess radiologic predictors of response and survival. Of particular interest was the impact of increased total tumor burden (TB), calculated as the sum of the largest diameter of all measurable lesions according to RECIST 1...
October 2018: Oral Oncology
Benita Tamrazi, Kshitij Mankad, Marvin Nelson, Felice D'Arco
Assessing tumor response is a large part of everyday clinical work in neuroradiology. However in the setting of tumor treatment, distinguishing tumor progression from treatment-related changes is difficult on conventional MRI sequences. This is made even more challenging in children where mainstay advanced imaging techniques that are often used to decipher progression versus treatment-related changes have technical limitations. In this review, we highlight the challenges in pediatric neuro-oncologic tumor assessment with discussion of pseudophenomenon including pseudoresponse and pseudoprogression...
December 2018: Pediatric Radiology
Roberto Ferrara, Laura Mezquita, Matthieu Texier, Jihene Lahmar, Clarisse Audigier-Valette, Laurent Tessonnier, Julien Mazieres, Gerard Zalcman, Solenn Brosseau, Sylvestre Le Moulec, Laura Leroy, Boris Duchemann, Corentin Lefebvre, Remi Veillon, Virginie Westeel, Serge Koscielny, Stephane Champiat, Charles Ferté, David Planchard, Jordi Remon, Marie-Eve Boucher, Anas Gazzah, Julien Adam, Emilio Bria, Giampaolo Tortora, Jean-Charles Soria, Benjamin Besse, Caroline Caramella
Importance: Hyperprogressive disease (HPD) is a new pattern of progression recently described in patients with cancer treated with programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) inhibitors. The rate and outcome of HPD in advanced non-small cell lung cancer (NSCLC) are unknown. Objectives: To investigate whether HPD is observed in patients with advanced NSCLC treated with PD-1/PD-L1 inhibitors compared with single-agent chemotherapy and whether there is an association between treatment and HPD...
November 1, 2018: JAMA Oncology
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