Division of Medical Oncology, Departmant of Internal Medicine, Ege University Medical Faculty, 35100 Izmir, Turkey.
Curr Oncol. 2024 Oct 18;31(10):6343-6355. doi: 10.3390/curroncol31100472.
Hyperprogressive disease (HPD) is described as the unexpected rapid growth of a tumour accompanied by a decline in performance status. While immune checkpoint inhibitors (ICIs) have improved outcomes in advanced melanoma, HPD remains a significant challenge in a subset of patients. Although HPD has been extensively studied in various solid tumours, research specifically focusing on advanced melanoma remains limited. We analysed 158 advanced melanoma patients, with 66.5% ( = 105) receiving anti-PD-1 and 33.5% ( = 53) receiving nivolumab plus ipilimumab. The median overall survival was 4.9 months for patients with HPD compared to 8.9 months for those with progressive disease without HPD ( = 0.014). Factors associated with HPD included liver metastasis ( = 0.002), three or more metastatic sites ( < 0.001), elevated lactate dehydrogenase levels ( = 0.004), and Eastern cooperative oncology group performance status ≥2 ( = 0.023). Multivariate analysis identified the Royal Marsden Hospital score (HR 3.675, 95% CI: 1.166-11.580, = 0.026) as an independent risk factor for HPD, with the MDA-ICI score also trending towards significance (HR 4.466, 95% CI: 0.947-21.061, = 0.059). This study provides valuable insights into the frequency and factors associated with HPD in advanced melanoma patients treated with ICIs, highlighting the relevance of clinical markers and scoring systems in predicting HPD risk.
超进展性疾病（HPD）是指肿瘤的意外快速生长，同时伴有体能状态下降。虽然免疫检查点抑制剂（ICIs）改善了晚期黑色素瘤的预后，但在一部分患者中，HPD 仍然是一个重大挑战。虽然 HPD 在各种实体瘤中得到了广泛研究，但专门针对晚期黑色素瘤的研究仍然有限。我们分析了 158 例晚期黑色素瘤患者，其中 66.5%（=105 例）接受了抗 PD-1 治疗，33.5%（=53 例）接受了纳武单抗联合伊匹单抗治疗。HPD 患者的中位总生存期为 4.9 个月，而无 HPD 的进展性疾病患者的中位总生存期为 8.9 个月（=0.014）。与 HPD 相关的因素包括肝转移（=0.002）、三个或更多转移部位（＜0.001）、乳酸脱氢酶水平升高（=0.004）和东部肿瘤协作组体能状态≥2（=0.023）。多因素分析确定皇家马斯登医院评分（HR 3.675，95%CI：1.166-11.580，=0.026）是 HPD 的独立危险因素，MDA-ICI 评分也有显著趋势（HR 4.466，95%CI：0.947-21.061，=0.059）。本研究提供了关于接受 ICI 治疗的晚期黑色素瘤患者中 HPD 的频率和相关因素的有价值的见解，强调了临床标志物和评分系统在预测 HPD 风险方面的相关性。
