Yildirim Hasan Cagri, Guven Deniz Can, Aktepe Oktay Halit, Taban Hakan, Yilmaz Feride, Yasar Serkan, Aksoy Sercan, Erman Mustafa, Kilickap Saadettin, Yalcin Suayib
Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06230, Turkey.
Department of Medical Oncology, Istinye University, Istanbul 34010, Turkey.
J Clin Med. 2022 Sep 1;11(17):5171. doi: 10.3390/jcm11175171.
Purpose: With the widespread use of immunotherapy agents, we encounter treatment responses such as hyperprogression disease (HPD) that we have not seen with previous standard chemotherapy and targeted therapies. It is known that survival in patients with HPD is shorter than in patients without HPD. Therefore, it is important to know the factors that will predict HPD. We aimed to identify HPD-related factors in patients treated with immunotherapy. Methods: A total of 121 adult metastatic cancer patients treated with immunotherapy for any cancer were included. Baseline demographics, the ECOG performance status, type of tumors and baseline blood count parameters were recorded. Possible predisposing factors were evaluated with univariate and multivariate analyses. Results: The median age was 62.28 (interquartile range (IQR) 54.02−67.63) years, and the median follow-up was 12.26 (IQR 5.6−24.36) months. Renal cell carcinoma (33%) and melanoma (33.8%) were the most common diagnoses. Twenty patients (16.5%) had HPD. A high LDH level (p: 0.001), hypoalbuminemia (p: 0.016) and an NLR > 5 (p: 0.007) were found to be associated with hyperprogression. Sex (female vs. male, p: 0.114), age (>65 vs. <65, p: 0.772), ECOG (0 vs. 1−4, p: 0.480) and the line of treatment (1−5, p: 0.112) were not found to be associated with hyperprogression. Conclusions: In this study, we observed HPD in 16.5% of immunotherapy-treated patients and increased HPD risk in patients with a high LDH level (p: 0.001), hypoalbuminemia (p: 0.016) and an NLR > 5 (p: 0.007).
随着免疫治疗药物的广泛应用，我们遇到了诸如超进展性疾病（HPD）等以往标准化疗和靶向治疗中未曾见过的治疗反应。已知HPD患者的生存期短于无HPD的患者。因此，了解预测HPD的因素很重要。我们旨在确定接受免疫治疗患者中与HPD相关的因素。方法：纳入121例接受免疫治疗的成年转移性癌症患者，治疗的癌症类型不限。记录基线人口统计学数据、东部肿瘤协作组（ECOG）体能状态、肿瘤类型和基线血常规参数。通过单因素和多因素分析评估可能的诱发因素。结果：中位年龄为62.28岁（四分位间距（IQR）54.02 - 67.63岁），中位随访时间为12.26个月（IQR 5.6 - 24.36个月）。肾细胞癌（33%）和黑色素瘤（33.8%）是最常见的诊断类型。20例患者（16.5%）出现HPD。发现乳酸脱氢酶（LDH）水平升高（p：0.001）、低白蛋白血症（p：0.016）和中性粒细胞与淋巴细胞比值（NLR）>5（p：0.007）与超进展相关。性别（女性与男性，p：0.114）、年龄（>65岁与<65岁，p：0.772）、ECOG（0分与1 - 4分，p：0.480）和治疗线数（1 - 5线，p：0.112）与超进展无关。结论：在本研究中，我们观察到16.5%接受免疫治疗的患者出现HPD，且LDH水平升高（p：0.001）、低白蛋白血症（p：0.016）和NLR>5（p：0.007）的患者发生HPD的风险增加。
