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Tumor Pseudoprogression

Jung Youn Kim, Ji Eun Park, Youngheun Jo, Woo Hyun Shim, Soo Jung Nam, Jeong Hoon Kim, Roh-Eul Yoo, Seung Hong Choi, Ho Sung Kim
Background: Pseudoprogression is a diagnostic challenge in early post-treatment glioblastoma. We therefore developed and validated a radiomics model using multiparametric MRI to differentiate pseudoprogression from early tumor progression in patients with glioblastoma. Methods: The model was developed from the enlarging contrast-enhancing portions of 61 glioblastomas within 3 months after standard treatment with 6472 radiomic features being obtained from contrast-enhanced T1-weighted imaging, fluid-attenuated inversion recovery imaging, and apparent diffusion coefficient (ADC), and cerebral blood volume (CBV) maps...
August 11, 2018: Neuro-oncology
Michael H Soike, Emory R McTyre, Nameeta Shah, Ralph B Puchalski, Jordan A Holmes, Anna K Paulsson, Lance D Miller, Christina K Cramer, Glenn J Lesser, Roy E Strowd, William H Hinson, Ryan T Mott, Annette J Johnson, Hui-Wen Lo, Adrian W Laxton, Stephen B Tatter, Waldemar Debinski, Michael D Chan
PURPOSE: For glioblastoma (GBM), imaging response (IR) or pseudoprogression (PSP) is frequently observed after chemoradiation and may connote a favorable prognosis. With tumors categorized by the Cancer Genome Atlas Project (mesenchymal, classical, neural, and proneural) and by methylguanine-methyltransferase (MGMT) methylation status, we attempted to determine if certain genomic or molecular subtypes of GBM were specifically associated with IR or PSP. METHODS: Patients with GBM treated at two institutions were reviewed...
August 10, 2018: Neuroradiology
J Fuentes-Antrás, M Provencio, E Díaz-Rubio
Cancer research is living a time of unparalleled expectations around immunotherapy, a therapeutic strategy that materializes the elegant idea of weaponizing our immune system to eradicate tumor cells. In an everchanging standard of care, a growing number of studies have shown that immunotherapy may accelerate tumor progression in a significant subset of patients ranging from 4% to 29% across multiple histologies. The identification of hyperprogression poses a challenge for RECIST criteria, which fail to capture pre- and post-treatment tumor growth kinetics at early times of disease...
July 18, 2018: Cancer Treatment Reviews
Thomas A Vander Jagt, Lara E Davis, Meghna Das Thakur, Carl Franz, Jeffery M Pollock
Immune checkpoint inhibitors are increasingly used in treatment of metastatic renal cell carcinoma, melanoma, and nonsmall cell lung cancer, as well as in clinical trials for novel targets. We present a pediatric patient with metastatic alveolar soft part sarcoma who was treated with MPDL3280 (Atezolizumab), a monoclonal anti-programmed death ligand-1 antibody. Imaging results for the patient suggested disease progression of multiple brain metastases with stable systemic disease. The patient met response evaluation criteria in solid tumors (RECIST) criteria of progression of disease and was removed from treatment with MPDL3280...
August 2018: Radiology Case Reports
Akihiro Yoshimura, Chieko Takumi, Taisuke Tsuji, Ryosuke Hamashima, Shinsuke Shiotsu, Tatsuya Yuba, Yoji Urata, Noriya Hiraoka
Pseudoprogression was reported as one of the unconventional responses during immune checkpoint inhibitor therapy. A 70-year-old man with pulmonary pleomorphic carcinoma received nivolumab therapy. Pleural effusion and pulmonary metastasis increased, however then shrank and serum cytokeratin 19 fragment levels decreased. Serum tumor marker might help to distinguish pseudoprogression.
July 2018: Clinical Case Reports
Lucian Beer, Maximilian Hochmair, Helmut Prosch
Immunotherapies comprise of a class of cancer therapies that are increasingly used for treatment of several cancer entities. Active immunotherapies encompassing immune checkpoint inhibitors are the most widespread class of immunotherapies, with indications for melanoma, non-small lung cancer, renal cell carcinoma, urothelial carcinoma, head and neck squamous cell carcinoma, and Hodgkin's lymphoma. Immune checkpoint inhibitors have demonstrated unique response patterns that are not adequately captured by traditional response criteria such das the Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization criteria...
2018: Memo
Guihong Liu, Tao Chen, Ronghui Li, Li Zhu, Dingyi Liu, Zhenyu Ding
Squamous cancer (SqCC) of the lung has a poor prognosis. With the advent of immunotherapy, prognosis has tended to improve; however, pseudoprogression poses a challenge to the management of immunotherapy. Herein, we discuss the case of a 47-year-old heavy smoker with advanced SqCC. The patient had recurrent disease after initial successful control of the tumor by concurrent radiochemotherapy, together with ample pleural effusion. Pleural effusion was well controlled with systematic nivolumab and intra-thoracic recombinant endostatin; however with simultaneous deterioration of performance and tumor progression...
July 6, 2018: Thoracic Cancer
Riccardo Soffietti, Alessia Pellerino, Roberta Rudà
Breast cancer (BC) is a heterogeneous disease. Different subtypes of BC exhibit a peculiar natural history, metastatic potential and outcome. Stereotactic radiosurgery is the most used treatment for brain metastases (BM), while surgery is reserved for large and symptomatic lesions. Whole-brain radiotherapy is employed in multiple BM not amendable to radiosurgery or surgery, and it is not employed any more following local treatments of a limited number of BM. A critical issue is the distinction from pseudoprogression or radionecrosis, and tumor regrowth...
July 2018: Future Oncology
Magdalena Philipp, Nina Frischhut, Antonia Tschachler, Fabian Steinkohl, Georg Weinlich, Matthias Schmuth, Van Anh Nguyen
In this case report, we describe a patient with an inoperable mucosal melanoma of the sinonasal cavity who achieved an ongoing complete response to combined immunotherapy with ipilimumab and nivolumab after initial pseudoprogression. Despite massive enlargement of the tumor 9 weeks after treatment initiation, we decided to continue with checkpoint inhibitor immunotherapy because of lacking potent therapeutic alternatives and the possibility of pseudoprogression. In the computed tomography scan 3 months later, the tumor was no longer detectable...
June 26, 2018: Anti-cancer Drugs
Roberto Ferrara, Sara Pilotto, Mario Caccese, Giulia Grizzi, Isabella Sperduti, Diana Giannarelli, Michele Milella, Benjamin Besse, Giampaolo Tortora, Emilio Bria
Immune checkpoint inhibitors (ICI) have widely reshaped the treatment paradigm of advanced cancer patients. Although multiple studies are currently evaluating these drugs as monotherapies or in combination, the choice of the most accurate statistical methods, endpoints and clinical trial designs to estimate the benefit of ICI remains an unsolved methodological issue. Considering the unconventional patterns of response or progression [i.e., pseudoprogression, hyperprogression (HPD)] observed with ICI, the application in clinical trials of novel response assessment tools (i...
May 2018: Journal of Thoracic Disease
Madison R Hansen, Edward Pan, Andrew Wilson, Morgan McCreary, Yeqi Wang, Thomas Stanley, Marco C Pinho, Xiaohu Guo, Darin T Okuda
PURPOSE: Pseudoprogression is often indistinguishable from true tumor progression on conventional 2-dimensional (2D) MRI in glioblastoma multiforme (GBM) patients. The aim of this study was to determine the association between post-gadolinium 3-dimensional (3D) characteristics and clinical state in GBM patients. METHODS: Standardized 3D brain MRI studies were performed, and contrast enhancing portions of each tumor were segmented and analyzed, blinded to clinical state, using principal component analysis (PCA), medial axis transformation (MAT), and coverage analysis...
June 7, 2018: Journal of Neuro-oncology
G Fernández Pérez, R Sánchez Escribano, A M García Vicente, A Luna Alcalá, J Ceballos Viro, R C Delgado Bolton, J C Vilanova Busquets, P Sánchez Rovira, M P Fierro Alanis, R García Figueiras, J E Alés Martínez
Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes...
July 2018: Radiología
Ecaterina Ileana Dumbrava, Veronica Smith, Rasha Alfattal, Adel K El-Naggar, Marta Penas-Prado, Apostolia M Tsimberidou
Immune checkpoint inhibitors such as anti-CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), anti PD-1 (programmed cell death protein 1) and PD-L1 (programmed cell death protein-ligand 1) monoclonal antibodies are emerging as standard oncology treatments in various tumor types. The indications will expand as immunotherapies are being investigated in various tumors with promising results. Currently, there is inadequate identification of predictive biomarkers of response or toxicity. Unique response patterns include pseudoprogression and delayed response...
May 21, 2018: Journal of Immunotherapy
Sied Kebir, Laurèl Rauschenbach, Gerrit H Gielen, Niklas Schäfer, Theophilos Tzaridis, Björn Scheffler, Frank A Giordano, Lazaros Lazaridis, Ulrich Herrlinger, Martin Glas
In a subset of glioblastoma (GBM) patients, the differentiation between tumor progression and tumor pseudoprogression (PsP) is challenging. This case describes a male patient suffering from isocitrate dehydrogenase 1 (IDH1) mutant GBM who demonstrated an increasing contrast-enhancing (CE) lesion on a cranial magnetic resonance imaging (cMRI) scan 8 months after radiochemotherapy. In accordance with the response assessment in neuro-oncology (RANO) criteria, the cMRI lesion was classified as recurrent tumor, although 18 F-fluoroethyl-L-tyrosine positron emission tomography (18 F-FET-PET) did not indicate vital tumor tissue...
July 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Sharyn I Katz, Mark Hammer, Stephen J Bagley, Charu Aggarwal, Joshua M Bauml, Jeffrey C Thompson, Arun C Nachiappan, Charles B Simone, Corey J Langer
INTRODUCTION: Anti-programmed cell death protein 1 (PD-1) therapy can lead to unconventional tumor responses, including radiologic pseudoprogression. Here we have determined the real-world incidence of radiologic pseudoprogression in advanced NSCLC and compared radiologic response criteria for assessment of disease response. METHODS: The electronic medical records of all patients with NSCLC who were receiving anti-PD-1 therapy at our institution over a 3-year period were retrospectively reviewed, and patients with clinically suspected radiologic pseudoprogression were identified...
July 2018: Journal of Thoracic Oncology
Stefanie C Thust, Martin J van den Bent, Marion Smits
This review describes the definition, incidence, clinical implications, and magnetic resonance imaging (MRI) findings of pseudoprogression of brain tumors, in particular, but not limited to, high-grade glioma. Pseudoprogression is an important clinical problem after brain tumor treatment, interfering not only with day-to-day patient care but also the execution and interpretation of clinical trials. Radiologically, pseudoprogression is defined as a new or enlarging area(s) of contrast agent enhancement, in the absence of true tumor growth, which subsides or stabilizes without a change in therapy...
May 7, 2018: Journal of Magnetic Resonance Imaging: JMRI
Alvin S Wong, Yee-Liang Thian, Jeevesh Kapur, Cheng-Nang Leong, Patrick Kee, Chun-Tsu Lee, Martin B Lee
The advent of immune checkpoint targeted immunotherapy has seen a spectrum of immune-related phenomena in both tumor responses and toxicities. We describe a case of pseudoprogression that pushes the limits of immune-related response criteria and challenges the boundaries and definitions set by trial protocols. A middle-aged man with conventional clear cell renal cell carcinoma (RCC) had received multiple prior systemic treatments including vascular endothelial growth factor receptor tyrosine kinase inhibitors, as well as multiple surgeries and radiotherapy treatments...
July 2018: Cancer Immunology, Immunotherapy: CII
Christine M Parseghian, Madhavi Patnana, Priya Bhosale, Kenneth R Hess, Ya-Chen Tina Shih, Bumyang Kim, Scott Kopetz, Michael J Overman, Gauri R Varadhachary, Milind Javle, Aung Naing, Sarina Piha-Paul, David Hong, Hung Le, Vivek Subbiah, Shubham Pant
Pseudoprogression has been observed in patients with various tumor types treated with immunotherapy. However, the frequency of pseudoprogression is unknown in gastrointestinal malignancies. Metastatic colorectal cancer (mCRC) and advanced pancreatic ductal adenocarcinoma (PDAC) patients who progressed on treatment with immunotherapy beyond RECIST version 1.1 criteria were analyzed. Degree of progression, tumor markers, time to progression, overall survival, Eastern Cooperative Oncology Group Performance Status (ECOG PS), and costs were analyzed for patients treated beyond progression (TBP) and not treated beyond progression...
July 2018: Journal of Immunotherapy
Randy F Sweis, Yuanyuan Zha, Lomax Pass, Brian Heiss, Tara Chongsuwat, Jason J Luke, Thomas F Gajewski, Russell Szmulewitz
BACKGROUND: Immunotherapies targeting the PD-1 checkpoint pathway have recently gained regulatory approval in numerous cancer types. With the widespread use of immune checkpoint therapies, varying patterns of responses and immune-related adverse events are being observed. CASE PRESENTATION: In this case, we highlight a patient who developed recurrent, large-volume ascites, while simultaneously having a 49% reduction in peritoneal tumor lesion size by RECIST criteria...
April 4, 2018: Journal for Immunotherapy of Cancer
Pejman Jabehdar Maralani, Kathleen Winger, Sean Symons, Matylda Machnowska, Chinthaka Heyn, Ali Helmi, Aimee Chan, Chia-Lin Tseng, Arjun Sahgal
BACKGROUND: Tumor osseous pseudoprogression (PP), defined as an imaging-based transient increase in tumor size following treatment, was recently described in patients with spinal metastases following stereotactic body radiation therapy. Distinguishing PP from true tumor progression is critical. OBJECTIVE: To describe the incidence, time of onset, and time range of PP following stereotactic body radiation therapy in patients treated for spinal metastases from either prostate cancer (PC) or renal cell carcinoma (RCC), and associated predictive factors...
March 29, 2018: Neurosurgery
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