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Jeong Eun Lee



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    EP1.04 - Immuno-oncology (ID 194)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Immuno-oncology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.04-08 - Is Pseudoprogression Really Uncommon After Immunotherapy in Lung Cancer? (Now Available) (ID 1118)

      08:00 - 18:00  |  Presenting Author(s): Jeong Eun Lee

      • Abstract
      • Slides

      Background

      Immune checkpoint inhibitors (ICIs) are more effective and less toxic than cytotoxic chemotherapy, which has led to change in the paradigm of lung cancer treatment. However, unlike classical chemotherapy, pseudoprogression has been reported in which the size of a lesion is temporarily increased or a new lesion occurs due to the effect of treatment, not the actual progress of disease. Pseudoprogression was histologically confirmed by necrosis or inflammatory cell infiltration, which is thought to be due to immune-related responses. To date, the incidence of pseudoprogression has been reported to be 4-6% in lung cancer patients. The aim of this study was to evaluate the incidence and prognosis of pseudoprogression in lung cancer patients treated with ICIs.

      Method

      We retrospectively analyzed 74 patients who received ICIs at Chungnam National University Hospital from January 2017 to October 2018. Chest x-ray was examined 1 week after the first treatment to identify changes in initial lesions after immunotherapy. The response was evaluated in accordance with RECIST 1.1 and evaluated in chest x-ray as well as computed tomography (CT). Pseudoprogression was defined as the case in which the response was confirmed after continued treatment when the disease progression was showed on chest x-ray or CT.

      Result

      Five patients (6.8%) had partial response (PR) on the chest x-ray at 1 week after treatment, and PR of the first response evaluation CT was observed in 15 patients (20.3%). All 5 patients who had PR in the first week x-ray showed response in CT. On the other hand, 36 patients (48.6%) had increased tumor lesions at the first week after treatment. Of these, 24 patients were progression disease (PD), 6 patients were PR, and 6 patients were stable disease (SD) on CT at 2 months after treatment. Pseudoprogression was observed in 15 of 74 patients, with a frequency of 20.3%, which was higher than previously reported. Twelve patients (80%) had progression of lesion on chest x-ray at 1 week after treatment, and showed decreased lesion size on response evaluation CT. Of the 12 patients with early pseudoprogression, 4 patients were unable to proceed with further treatment due to progression-related symptoms and systemic deterioration.

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      Conclusion

      Unlike previous studies, pseudoprogression after immunotherapy is more frequent in lung cancer patients, especially during the early stage of treatment. Pseudoprogression at the beginning of treatment is relatively common to cause symptoms, so it is important to monitor early in the treatment.

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