Thomas Richard, Somarouthu Bhanusupriya, Alessandrino Francesco, Kurra Vikram, Shinagare Atul B
Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215.
Department of Radiology, Brigham and Women's Hospital, Boston, MA.
AJR Am J Roentgenol. 2019 Jun;212(6):1177-1181. doi: 10.2214/AJR.18.20938. Epub 2019 Mar 27.
The purpose of this study is to assess the frequency of atypical response patterns in oncology patients treated with the programmed cell death protein-1 inhibitor nivolumab. This retrospective study included 254 patients treated with nivolumab alone or in combination, from January 2013 through August 2017. A blinded reader prospectively assessed treatment response. Among 166 patients (65%) who experienced a clinical benefit (defined as stable disease, partial response, or complete response as the best response), four response patterns were identified: pattern 1 is a decrease or less than 20% increase in the sum of the longest dimension (SLD) without a return to below the nadir, pattern 2 is a 10-19% increase in SLD with a return to below the nadir, pattern 3 is a 20% or greater increase in SLD with a return to below the nadir (classic pseudoprogression), and pattern 4 is the development of new lesions with a decrease in SLD lasting through at least two consecutive scans. Patterns 2, 3, and 4 were defined as atypical response patterns. Of 166 patients who experienced a clinical benefit, pattern 1 was seen in 133 (80%), pattern 2 was seen in 15 (9%), pattern 3 was seen in two (1%), and pattern 4 was seen in 16 (10%) patients. Thus, atypical response patterns were seen in 33 (20%) patients who experienced a clinical benefit, including 25 of 91 (27%) taking nivolumab and ipilimumab combined, six of 46 (13%) taking nivolumab alone, and two of 29 (7%) taking a combination of nivolumab and another chemotherapeutic agent ( = 0.02). Although classic pseudoprogression was rare, an atypical response was seen in 20% of patients who experienced a clinical benefit, and a delayed response up to 24 months of therapy may be seen. Radiologists should be aware of these atypical patterns to avoid errors in response assessment.
本研究的目的是评估接受程序性细胞死亡蛋白1抑制剂纳武单抗治疗的肿瘤患者中不典型反应模式的出现频率。这项回顾性研究纳入了2013年1月至2017年8月期间单独或联合使用纳武单抗治疗的254例患者。一名盲法阅片者前瞻性评估治疗反应。在166例（65%）有临床获益（定义为疾病稳定、部分缓解或完全缓解作为最佳反应）的患者中，识别出四种反应模式：模式1是最长径总和（SLD）减少或增加小于20%且未恢复至最低点以下，模式2是SLD增加10% - 19%且恢复至最低点以下，模式3是SLD增加20%或更多且恢复至最低点以下（经典假性进展），模式4是出现新病灶且SLD减少持续至少两次连续扫描。模式2、3和4被定义为不典型反应模式。在166例有临床获益的患者中，模式1见于133例（80%），模式2见于15例（9%），模式3见于2例（l%），模式4见于16例（10%）患者。因此，在166例有临床获益的患者中，33例（20%）出现不典型反应模式，包括91例接受纳武单抗和伊匹单抗联合治疗患者中的25例（27%）、46例单独接受纳武单抗治疗患者中的6例（13%）以及29例接受纳武单抗与另一种化疗药物联合治疗患者中的2例（7%）（P = 0.02）。虽然经典假性进展很少见，但在20%有临床获益的患者中出现了不典型反应，并且可能出现长达24个月治疗的延迟反应。放射科医生应了解这些不典型模式，以避免反应评估中的错误。
