Immunotherapy Linked to Hyperprogressive Disease in NSCLC

Submitted by onc_editor on Fri, 12/22/2017 - 16:25

Immunotherapy is associated with the development of hyperprogressive disease (HPD) in approximately 16% of patients with advanced non-small cell lung cancer (NSCLC), according to a recent study.

Findings from the study were presented on September 10, 2017, at the ESMO 2017 Conference (Madrid, Spain).

For their study, Roberto Ferrara and colleagues assessed 242 eligible patients with NSCLC who had been treated with immunotherapy between November 2012 and March 2017. Median follow-up lasted 10 months. Patients were included in the study if they had undergone 3 CT scans prior to immunotherapy, at baseline, and during immunotherapy, and if each scan had been centrally reviewed by a senior radiologist and evaluated based on RECIST 1.1 criteria.

Tumor growth rate (TGR) was calculated at baseline of immunotherapy and during immunotherapy, along with the variation per month of TGR between both (delta TGR). HPD was defined as an increase of 50% in absolute delta TGR. The Kaplan-Meier method was used to estimate median overall survival (OS) and median progression-free survival (PFS).

Of the 242 patients included in the study, more than 90% of patients received single agent PD1-inhibitor in at least their second line of therapy. Results indicated that response rate to immunotherapy was 15%, while median PFS was 3.9 months and median OS was 13.4 months. TGR had decreased during immunotherapy in 64% of patients and increased in 36% of patients, compared with baseline.

Ultimately, the researchers found that 40 (16%) patients had developed HPD. However, three (1.2%) patients, of whom two were initially qualified as HPD, had confirmed pseudo-progression. Patients with HPD had significantly lower median PFS (1.4 months) vs non-HPD patients (4.9 months).

The researchers noted that there had been no differences in tumor burden baseline, clinical, molecular, pathological characteristics, PD-L1 status, and response rate to treatment between HPD and not-HPD patients.

“HPD occurs in 16% of 242 advanced NSCLC [patients] treated with immunotherapy, leading to decreased survival,” the researchers concluded. “Further work is needed to better characterize this population.”—Christina Vogt