Ibáñez-Juliá Maria José, Bataller Luis, Cabello-Murgui Francisco Javier, Nguyen-Them Ludovic, Alentorn Agusti, Torres-Martínez Alba, Mazón-Momparler Miguel, Gironés-Sarrió Regina
Neuroscience Department Ascires Biomedical Group, Valencia, Spain.
Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
J Neurooncol. 2025 May 27. doi: 10.1007/s11060-025-05091-0.
Immune checkpoint inhibitors (ICIs) are increasingly used in cancer treatment, resulting in the emergence of various immune-related adverse effects, including pseudoprogression (PsP). We sought to evaluate the characteristics of pseudoprogression in adults treated with ICIs for brain tumors (either primary or secondary), and to compare it with a non- PsP group.
We retrospectively identified adults with brain tumors treated with ICIs at our institution between 2015 and 2023. Eligibility required one brain magnetic resonance imaging scan prior to treatment and another obtained within 6 months after treatment initiation. PsP was defined as radiological worsening within 6 months of ICI initiation, followed by stabilization or improvement without therapy modification. Demographic, clinical, and radiological characteristics were analyzed and compared between the PsP and the non-PsP groups.
Among 102 eligible patients, 10 (9.8%) developed PsP. Clinical symptoms occurred in 4 (40%) cases, all of which showed favorable outcomes with corticosteroid therapy. The PsP group had higher baseline tumor burden (p = 1.29 × 10⁻¹³) and higher PD-L1 expression (p < 0.001) than the non-PsP group. Median progression-free survival and overall survival were numerically longer in the PsP group with no significant difference.
PsP is a frequent complication of ICIs. We describe 4 symptomatic patients with pseudoprogression, challenging the iRANO criteria that recommend excluding this diagnosis in symptomatic cases. Clinical impairment should not automatically rule out pseudoprogression, and each case requires thorough evaluation. High PD-L1 expression and greater tumor burden may be associated with PsP, but further studies are needed to confirm these findings.
免疫检查点抑制剂（ICI）在癌症治疗中的应用日益广泛，导致出现了各种免疫相关不良反应，包括假性进展（PsP）。我们旨在评估接受ICI治疗的成人脑肿瘤（原发性或继发性）患者假性进展的特征，并将其与非假性进展组进行比较。
我们回顾性确定了2015年至2023年期间在我们机构接受ICI治疗的成年脑肿瘤患者。入选标准要求在治疗前进行一次脑磁共振成像扫描，并在开始治疗后6个月内进行另一次扫描。PsP定义为ICI开始后6个月内影像学恶化，随后在未改变治疗方案的情况下病情稳定或改善。分析并比较了PsP组和非PsP组的人口统计学、临床和影像学特征。
在102例符合条件的患者中，10例（9.8%）出现了PsP。4例（40%）出现了临床症状，所有这些患者经皮质类固醇治疗后预后良好。与非PsP组相比，PsP组的基线肿瘤负荷更高（p = 1.29×10⁻¹³），PD-L1表达更高（p < 0.001）。PsP组的无进展生存期和总生存期的中位数在数值上更长，但差异无统计学意义。
PsP是ICI的常见并发症。我们描述了4例有症状的假性进展患者，对国际放射肿瘤学、生物学和物理学（iRANO）标准提出了挑战，该标准建议在有症状的病例中排除这一诊断。临床损伤不应自动排除假性进展，每个病例都需要进行全面评估。高PD-L1表达和更大的肿瘤负荷可能与PsP有关，但需要进一步研究来证实这些发现。
