<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2018-0037_s_006_w2aab3b7b4b1b6b1aab1c18b1Aa"><h3>Background</h3><p>Uncommon response during immunotherapy is a new challenging issue in oncology practice. Recently, new criteria for evaluation of response to immunotherapy <italic>immune response evaluation criteria in solid tumors</italic> (iRECIST) were accepted. According to iRECIST, worsening of performance status (PS) accompanied to pseudoprogression reflects most probably the true progression of the malignant disease.</p></sec><sec id="j_raon-2018-0037_s_007_w2aab3b7b4b1b6b1aab1c18b2Aa"><h3>Methods</h3><p>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.</p></sec><sec id="j_raon-2018-0037_s_008_w2aab3b7b4b1b6b1aab1c18b3Aa"><h3>Results</h3><p>In the literature, we identified five reports of seven patients treated with immunotherapy that met the inclusion criteria. We also report our experience of patient with pseudoprogression and almost complete response after one dose of immunotherapy.</p></sec><sec id="j_raon-2018-0037_s_009_w2aab3b7b4b1b6b1aab1c18b4Aa"><h3>Conclusions</h3><p>As seen from our review, iRECIST criteria might be insufficient in distinguishing true progression from pseudoprogression in some patients with advanced NSCLC treated with immunotherapy. More precise assessment methods are urgently needed.</p></sec></abstract>

BackgroundUncommon 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.MethodsA 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.ResultsIn the literature, we identified five reports of seven patients treated with immunotherapy that met the inclusion criteria. We also report our experience of patient with pseudoprogression and almost complete response after one dose of immunotherapy.ConclusionsAs seen from our review, iRECIST criteria might be insufficient in distinguishing true progression from pseudoprogression in some patients with advanced NSCLC treated with immunotherapy. More precise assessment methods are urgently needed.

Immune RECIST criteria and symptomatic pseudoprogression in non-small cell lung cancer patients treated with immunotherapy

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundUncommon response during immunotherapy is a new challenging issue in oncology practice. Recently, new criteria for evaluation of response to...

Author, (Year), reference	Sex/age (years)	Histology	Initial stage	Line of systemic therapy	PD-L1 expression	Anti-PD-1/PD-L1	Time to PP	Symptoms of PP	Time to response (months)	Subsequent treatment (time)
Sarfay et al. (2016)¹⁷	F/68	squamous NSCLC	locally advanced	2	NR	nivolumab	1 week	Pain, sys.inflam.reac	4 weeks	NC (6m)
Kolla et al. (2016)¹⁸	M/46	SCLC	NR	11	NR	nivolumab	NR	SVCS, stenting req., Card. tamponade, Pericard.req. Card.tamponade	8 weeks	NC (12m)
	F/54	adenoca EGFR ex21	metastatic	5	NR	nivolumab	NR	Pericard.req	8 weeks	IT S, osi
Izumida et al. (2017)¹⁹	M/64	adenoca	metastatic	6	NR	nivolumab	2 months	Gen.det	3 months	IT S, IT reint. (11m)
Kumagai et al. (2017)²⁰	F/62	adenoca	locally advanced	7	NR	nivolumab	12 weeks	Hemoptysis, art.embol.req	20 weeks	Pacli, S-1
Hochmair et al. (2017)²¹	M/63 F/63	adenoca adenoca	locally advanced metastatic	22	90% Highly	pembrolizumab pembrolizumab	2 months 4 weeks	Resp.insuf. (O2 req) Gen.det., Resp.insuf.(O2 req)	6 weeks after PP 3 months	NC (13m) NC (19m)
Vrankar et al. (2018)	F/67	adenoca	metastatic	2	100%	pembrolizumab	2 weeks	Gen.det	3 months	IT reint. (11m)

Immune RECIST criteria and symptomatic pseudoprogression in non-small cell lung cancer patients treated with immunotherapy

Article Category: Research Article

Published Online: Oct 18, 2018

Page range: 365 - 369

Received: Feb 05, 2018

Accepted: Mar 12, 2018

DOI: https://doi.org/10.2478/raon-2018-0037

Keywords
symptomatic pseudoprogression, atypical response, immunotherapy, lung cancer

© 2018 Martina Vrankar, Mojca Unk, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Symptomatic pseudo progression: review of the literature

Immune RECIST criteria and symptomatic pseudoprogression in non-small cell lung cancer patients treated with immunotherapy

Article Category: Research Article

Published Online: Oct 18, 2018

Page range: 365 - 369

Received: Feb 05, 2018

Accepted: Mar 12, 2018

DOI: https://doi.org/10.2478/raon-2018-0037

Keywordssymptomatic pseudoprogression, atypical response, immunotherapy, lung cancer

© 2018 Martina Vrankar, Mojca Unk, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Symptomatic pseudo progression: review of the literature

Keywords
symptomatic pseudoprogression, atypical response, immunotherapy, lung cancer