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Fabio Vargas Magalhaes



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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
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.04-34 - Imaging Challenges in the Immunotherapy Treatment of Non Small Cell Lung Cancer (NSCLC): Progression vs. Pseudo Progression  (ID 2258)

      08:00 - 18:00  |  Author(s): Fabio Vargas Magalhaes

      • Abstract
      • Slides

      Background

      Immunotherapy has revolutionized treatment of squamous NSCLC. Along with the superior efficacy physicians have to face new side effects and response criteria. Initial tumor growth or new lesions followed by tumor response is called pseudo progression and can be seen in up to 10 % of patients.

      Method

      This education exhibit aims to show how the treatment response was evaluated in a series of cases of the clinical research of our institution using both RECIST and irRECIST, comparing the two methods and the multidisciplinary team consensus with correlation with the clinical status of the patient. Demonstrate the importance of the concept of unconfirmed progression and pseudo progression in the imaging evaluation of these patients. Illustrate with practical cases the diverse treatment outcomes.

      Result

      captura de tela 2019-04-10 às 7.47.25 am.png

      A65 yo female patiente receive atezolizumab in the second line treatment for NSCLC stage IV, after a pulmonar progression with carboplatin + paclitaxel treatment in first line. PD-L1 was unknown. EGFR and ALK was negative. After 3 cicles of treatment wih anti PD-L1 agent (radiological control 1) the RECIST 1.1 evaluation identified a pattern of progression of disease , becouse there was a new pulmonary nodule. The patient was improving clinically, with weigh gain and cough reduction and in the immune-related response criteria (irRC) a stable disease was the response in that moment, besides the new lesion appearance. She does not have any remarkable side effect with the treatment , thas was susteined becouse of the clinical benefit. In order to get a close follow up of the disease, after 2 months she did a new radiologic evaluation ( control 2) , that show the involution of that new lesion in the right inferior lobe as well as happen to other pulmonary lesions at the same time, what could be characterized by a pseudoprogression pattern of response.

      Conclusion

      We need to take care in the radiologic and clinical evaluation of response in immunotherapy. Besides thrue pseudoprogression pattern ir rare in NSCLC and it is not able to be captured by convencional RECIST evaluation, it need to be reminded. Is necessary to combine clinical evaluation and immune-related response criteria (irRC) in doubtful cases in order do not underestimate the benefit of immunotherapy and prevent premature cessation of treatment.

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