Belkouchi Younes, Talbot Hugues, Lassau Nathalie, Lawrance Littisha, Farhane Siham, Feki-Mkaouar Rahma, Hadchiti Joya, Dawi Lama, Vibert Julien, Cournède Paul-Henry, Cousteix Clara, Mazza Camille, Kind Michele, Italiano Antoine, Marabelle Aurelien, Ammari Samy, Champiat Stephane
Centre de vision numérique (CVN), CentraleSupélec, Université Paris-Saclay, Inria, Gif-Sur-Yvette, France.
Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay (BIOMAPS), UMR 1281. Université Paris-Saclay, Inserm, CNRS, Villejuif, France.
Clin Cancer Res. 2023 Apr 14;29(8):1528-1534. doi: 10.1158/1078-0432.CCR-22-0890.
The objective of the study is to propose the immunotherapy progression decision (iPD) score, a practical tool based on patient features that are available at the first evaluation of immunotherapy treatment, to help oncologists decide whether to continue the treatment or switch rapidly to another therapeutic line when facing a progressive disease patient at the first evaluation.
This retrospective study included 107 patients with progressive disease at first evaluation according to RECIST 1.1. Clinical, radiological, and biological data at baseline and first evaluation were analyzed. An external validation set consisting of 31 patients with similar baseline characteristics was used for the validation of the score.
Variables were analyzed in a univariate study. The iPD score was constructed using only independent variables, each considered as a worsening factor for the survival of patients. The patients were stratified in three groups: good prognosis (GP), poor prognosis (PP), and critical prognosis (CP). Each group showed significantly different survivals (GP: 11.4, PP: 4.4, CP: 2.3 months median overall survival, P < 0.001, log-rank test). Moreover, the iPD score was able to detect the pseudoprogressors better than other scores. On the validation set, CP patients had significantly worse survival than PP and GP patients (P < 0.05, log-rank test).
The iPD score provides oncologists with a new evaluation, computable at first progression, to decide whether treatment should be continued (for the GP group), or immediately changed for the PP and CP groups. Further validation on larger cohorts is needed to prove its efficacy in clinical practice.
本研究的目的是提出免疫治疗进展决策（iPD）评分，这是一种基于免疫治疗首次评估时可得的患者特征的实用工具，以帮助肿瘤学家在首次评估时面对疾病进展的患者时，决定是继续治疗还是迅速转向另一种治疗方案。
这项回顾性研究纳入了107例根据RECIST 1.1标准在首次评估时疾病进展的患者。分析了基线和首次评估时的临床、放射学和生物学数据。使用由31例具有相似基线特征的患者组成的外部验证集对该评分进行验证。
在单变量研究中对变量进行了分析。iPD评分仅使用独立变量构建，每个变量都被视为患者生存的恶化因素。患者被分为三组：预后良好（GP）、预后不良（PP）和预后危急（CP）。每组的总生存期有显著差异（GP组：中位总生存期11.4个月，PP组：4.4个月，CP组：2.3个月，P<0.001，对数秩检验）。此外，iPD评分比其他评分能更好地检测出假性进展者。在验证集中，CP组患者的生存期明显比PP组和GP组差（P<0.05，对数秩检验）。
iPD评分为肿瘤学家提供了一种在首次疾病进展时可计算的新评估方法，以决定是继续治疗（针对GP组），还是对PP组和CP组立即更换治疗方案。需要在更大的队列中进行进一步验证，以证明其在临床实践中的有效性。
