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Pseudoprogression in patients treated with immune checkpoint inhibitors for microsatellite instability-high/mismatch repair-deficient metastatic colorectal cancer
- Source :
- European Journal of Cancer, European Journal of Cancer, Elsevier, 2021, 144, pp.9-16. ⟨10.1016/j.ejca.2020.11.009⟩, European Journal of Cancer, 2021, 144, pp.9-16. ⟨10.1016/j.ejca.2020.11.009⟩
- Publication Year :
- 2021
- Publisher :
- HAL CCSD, 2021.
-
Abstract
- Background The efficacy of immune checkpoint inhibitors (ICIs) in microsatellite instability-high/DNA mismatch repair (MSI/dMMR) metastatic colorectal cancer (mCRC) is well established. ICIs are responsible for pseudoprogression (PSPD) that complicates clinical decisions. We evaluated the PSPD frequency in patients with MSI/dMMR mCRC treated with ICIs. Patients and methods Consecutive patients with MSI/dMMR mCRC treated with ICIs from February 2015 to December 2019 at Saint-Antoine Hospital were included. Imaging was retrospectively and centrally reviewed according to Response Evaluation Criteria in Solid Tumours, version 1.1 (RECIST 1.1) and immune RECIST (iRECIST). PSPD was defined as an unconfirmed disease progression by iRECIST. Results One hundred twenty-three patients with MSI/dMMR mCRC were included. Thirty-six patients (29%) had radiological PD according to RECIST 1.1 during the median follow-up of 22.3 months (95% confidence interval [CI], 1.5–62.2), including 22 in the first 3 months (the primary radiological PD). Twenty-nine patients continued ICIs beyond PD. Twelve patients experienced PSPD, representing 10% of the population and 52% of the primary radiological PD. The median time to PSPD was 5.7 weeks (95% CI, 4.1–11.4). No PSPD was observed after 3 months. The PSPD incidence was 14.8% in patients treated with anti-PD1 alone (n = 9/61) and 4.8% in case of anti-PD1 plus anti-CTLA-4 (n = 3/62). Eight patients with PSPD experienced an objective response. The 2-year progression-free survival and overall survival rates for patients with PSPD were 70.0% (95% CI, 32.9–89.2) and 75.0% (95% CI, 29.8–93.4), respectively. Conclusion Patients with MSI/dMMR mCRC treated with ICIs experienced PSPDs. PSPD occurred within the first 3 months and represented most of the primary radiological PDs. The use of iRECIST criteria should be questioned after 3 months.
- Subjects :
- 0301 basic medicine
Oncology
Male
Cancer Research
medicine.medical_specialty
Drug-Related Side Effects and Adverse Reactions
Colorectal cancer
Immune checkpoint inhibitors
[SDV]Life Sciences [q-bio]
Population
DNA Mismatch Repair
03 medical and health sciences
0302 clinical medicine
Internal medicine
Medicine
Humans
Neoplasm Metastasis
education
Pseudoprogression
Immune Checkpoint Inhibitors
Response Evaluation Criteria in Solid Tumors
Aged
Retrospective Studies
education.field_of_study
business.industry
Incidence (epidemiology)
Microsatellite instability
Middle Aged
medicine.disease
Prognosis
Confidence interval
3. Good health
Survival Rate
[SDV] Life Sciences [q-bio]
030104 developmental biology
030220 oncology & carcinogenesis
Disease Progression
DNA mismatch repair
Female
Microsatellite Instability
business
Colorectal Neoplasms
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 09598049
- Database :
- OpenAIRE
- Journal :
- European Journal of Cancer, European Journal of Cancer, Elsevier, 2021, 144, pp.9-16. ⟨10.1016/j.ejca.2020.11.009⟩, European Journal of Cancer, 2021, 144, pp.9-16. ⟨10.1016/j.ejca.2020.11.009⟩
- Accession number :
- edsair.doi.dedup.....4a95df449925d26937e6c4ab7c8e96ec