Wong Alvin, Vellayappan Balamurugan, Cheng Lenith, Zhao Joseph J, Muthu Vaishnavi, Asokumaran Yugarajah, Low Jia-Li, Lee Matilda, Huang Yi-Qing, Kumarakulasinghe Nesaretnam Barr, Ngoi Natalie, Leong Cheng-Nang, Chua Wynne, Thian Yee-Liang
Department of Haematology-Oncology, National University Cancer Institute, Singapore 119228, Singapore.
Department of Radiation Oncology, National University Cancer Institute, Singapore 119228, Singapore.
Cancers (Basel). 2021 Apr 2;13(7):1689. doi: 10.3390/cancers13071689.
Atypical response patterns have been a topic of increasing relevance since the advent of immune checkpoint inhibitors (ICIs), challenging the traditional RECIST (Response Evaluation Criteria in Solid Tumors) method of tumor response assessment. Newer immune-related response criteria can allow for the evolution of radiologic pseudoprogression, but still fail to capture the full range of atypical response patterns encountered in clinical reporting.
We did a detailed lesion-by-lesion analysis of the serial imaging of 46 renal cell carcinoma (RCC) patients treated with ICIs with the aim of capturing the full range of radiologic behaviour.
Atypical response patterns observed included pseudoprogression ( = 15; 32.6%), serial pseudoprogression ( = 4; 8.7%), dissociated response ( = 22; 47.8%), abscopal response ( = 9; 19.6%), late response ( = 5; 10.9%), and durable response after cessation of immunotherapy ( = 2; 4.3%). Twenty-four of 46 patients (52.2%) had at least one atypical response pattern and 18 patients (39.1%) had multiple atypical response patterns.
There is a high incidence of atypical response patterns in RCC patients receiving ICIs and the study contributes to the growing literature on the abscopal effect. The recognition of these interesting and overlapping radiologic patterns challenges the oncologist to tweak treatment options such that the clinical benefits of ICIs are potentially maximized.
自免疫检查点抑制剂（ICI）问世以来，非典型反应模式一直是一个越来越受关注的话题，对传统的实体瘤反应评估标准（RECIST）提出了挑战。更新的免疫相关反应标准可以考虑到放射学假性进展的演变，但仍无法涵盖临床报告中遇到的所有非典型反应模式。
我们对46例接受ICI治疗的肾细胞癌（RCC）患者的系列影像学资料进行了详细的逐病灶分析，目的是全面了解放射学表现。
观察到的非典型反应模式包括假性进展（n = 15；32.6%）、系列假性进展（n = 4；8.7%）、分离反应（n = 22；47.8%）、远隔效应（n = 9；19.6%）、延迟反应（n = 5；10.9%）以及免疫治疗停止后的持久反应（n = 2；4.3%）。46例患者中有24例（52.2%）至少有一种非典型反应模式，18例患者（39.1%）有多种非典型反应模式。
接受ICI治疗的RCC患者中非典型反应模式的发生率很高，该研究为关于远隔效应的文献不断增加做出了贡献。认识到这些有趣且相互重叠的放射学模式，促使肿瘤学家调整治疗方案以潜在地最大化ICI的临床益处。
