Kasparian Saro, Gentille Cesar, Burns Ethan, Bernicker Eric H
Department of Medicine, Houston Methodist Hospital, Houston, Texas.
Cancer Center, Houston Methodist Hospital, Houston, Texas.
JTO Clin Res Rep. 2020 Feb 22;1(2):100017. doi: 10.1016/j.jtocrr.2020.100017. eCollection 2020 Jun.
Immune-checkpoint inhibitors (ICIs) are transforming the modern era of cancer therapy. As new treatment options are becoming available, new patterns of disease behavior are manifesting. One such phenomenon, known as hyperprogressive disease (HPD), is a rare complication resulting in exponential disease progression on exposure to an ICI. Herein, we report an uncommon case of a patient who experienced HPD on 2 different occasions with 2 different immunotherapy agents.
A 77-year-old black man was diagnosed with stage IV squamous cell carcinoma of the lung. He was enrolled in a clinical trial that involved viral transduction and stereotactic body radiation followed by pembrolizumab administration. His disease progressed markedly after the first cycle of immunotherapy. He was switched to carboplatin and protein-bound paclitaxel. He continued to have steady disease progression. After the third cycle of chemotherapy, he was again given immunotherapy, this time with atezolizumab. Again, after a single infusion, he exhibited substantial disease progression and further clinical deterioration.
HPD is a rare yet disturbing complication of immunotherapy with devastating effects on morbidity and mortality. Although there is accumulating literature supporting the phenomenon of HPD, to our knowledge, this is the first reported case of HPD occurring with 2 different ICIs in the same patient. This case suggests that the presence of HPD during treatment with 1 checkpoint inhibitor may preclude the use of another one. It also raises concerns about using other forms of immunomodulating agents. As immunotherapy becomes a major form of cancer therapy, more data are needed to better understand HPD and determine which patients are at risk.
免疫检查点抑制剂（ICI）正在改变癌症治疗的现代时代。随着新的治疗选择不断涌现，新的疾病行为模式也在显现。一种这样的现象，称为超进展性疾病（HPD），是一种罕见的并发症，在接触ICI后会导致疾病呈指数级进展。在此，我们报告一例不寻常的病例，该患者在使用两种不同的免疫治疗药物时两次出现HPD。
一名77岁的黑人男性被诊断为IV期肺鳞状细胞癌。他参加了一项临床试验，该试验包括病毒转导和立体定向体部放疗，随后给予帕博利珠单抗。在免疫治疗的第一个周期后，他的疾病明显进展。他改用卡铂和蛋白结合型紫杉醇。他的疾病继续稳步进展。在化疗的第三个周期后，他再次接受免疫治疗，这次使用阿替利珠单抗。同样，在单次输注后，他出现了明显的疾病进展和进一步的临床恶化。
HPD是免疫治疗中一种罕见但令人不安的并发症，对发病率和死亡率具有毁灭性影响。尽管有越来越多的文献支持HPD现象，但据我们所知，这是首例同一患者使用两种不同ICI出现HPD的报道病例。该病例表明，在使用一种检查点抑制剂治疗期间出现HPD可能会妨碍使用另一种抑制剂。这也引发了对使用其他形式免疫调节剂的担忧。随着免疫治疗成为癌症治疗的主要形式，需要更多数据来更好地了解HPD并确定哪些患者有风险。
