Presented as a poster at the 4th National University Cancer Institute Annual Research Meeting (NCAM 2017) on 30th June 2017, Singapore.
A comment to this article is available online at https://doi.org/10.1007/s00262-018-2208-y.
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. He was eventually started on nivolumab—the anti-programmed death receptor-1 monoclonal antibody approved for the treatment of advanced RCC. Clinical deterioration was observed soon after a 100 mg dose of nivolumab, with onset of acute renal failure and declining performance status. Radiologic progression was documented in multiple sites including worsening tumor infiltration of his residual kidney. The patient was on palliative treatment and visited by the home hospice team in an end-of-life situation. The patient unexpectedly improved and went on to achieve a durable tumor response. The case is illustrative of an extreme manifestation of pseudoprogression, and impels us to probe the assumptions and controversies surrounding this phenomenon.
Ascierto PA, Vanella V, Grimaldi AM, Lucia F, Palla M, Simeone E, Mozillo N (2016) Complete response to nivolumab monotherapy in a treatment-naïve, BRAF wild-type patient with advanced mucosal melanoma and elevated lactate dehydrogenase: a case report from a phase III trial. Cancer Immunol Immunother 65(11):1395–1400 CrossRefPubMed
George S, Motzer RJ, Hammers HJ, Redman BG, Kuzel TM, Tykodi SS, Plimack ER, Jiang J, Waxman IM, Rini BI (2016) Safety and efficacy of nivolumab in patients with metastatic renal cell carcinoma treated beyond progression: a subgroup analysis of a randomized clinical trial. JAMA Oncol 2(9):1179–1186 CrossRefPubMedPubMedCentral
- Pushing the limits of immune-related response: a case of “extreme pseudoprogression”
Alvin S. Wong
Martin B. Lee
- Springer Berlin Heidelberg
Neu im Fachgebiet Onkologie
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