Atypical patterns of responses in the era of immune checkpoint inhibitors in head and neck cancer. (January 2020)

• Record Type: Journal Article
• Authors: Doumas, Stergios; Foukas, Periklis G.; Economopoulou, Panagiota; Kotsantis, Ioannis; Psyrri, Amanda
• Is Part Of: Oral oncology. Volume 100(2020)
• Publication Date: 2020-01
• Subjects: Immune checkpoint inhibitors -- Pseudoprogression -- Hyperprogression -- Asymptomatic progression -- Treatment beyond progression -- Biomarkers; CTLA-4 Cytotoxic T lymphocyte protein 4 -- EGFR Epidermal Growth Factor Receptor -- EMA European Medicine's Agency -- FDA Food and Drug Administration -- HNSCC Head and Neck Squamous Cell Carcinoma -- HPD Hyperprogressive Disease -- ICI Immune Checkpoint Inhibitors -- iCPD Immune confirmed Progressive Disease -- iCR Immune Complete Response -- IGF1 Insulin Growth Factor 1 -- ILC2 Innate Lymphoid Cells -- iPR Immune Partial Response -- irAEs Immune Related Adverse Events -- irRC Immune Related Response Criteria -- iSD Immune Stable Disease -- iUPD Immune Unconfirmed Progressive Disease -- OS Overall survival -- PD-1 Programmed Cell Death Protein -- PDL-1 Programmed Cell Death Ligand 1 -- RECIST Response Evaluation Criteria in Solid Tumors -- R/M Recurrent/Metastatic -- SOC Standard of Care -- TBP Treatment Beyond Progression -- TGF Transforming Growth Factor -- TGR Tumour Growth Rate -- TILs Tumour Infiltrating Lymphocytes -- Tregs T regulatory cells -- TTF Time to Treatment Failure -- VEGF Vascular Endothelial Growth Factor; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2019.104477
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Pseudoprogression and hyperprogression are atypical patterns of response to immunotherapy. Current radiologic criteria are suboptimal for management of hyperprogression. A better understanding of molecular basis of hyperpogression is essential. Abstract: The discovery and implementation into everyday clinical practice of immune checkpoint inhibitors (ICIs) has marked a therapeutic renaissance in the treatment of advanced solid tumors. In head and neck cancer, nivolumab and pembrolizumab have both been approved for recurrent/metastatic disease based on robust clinical activity observed in landmark phase III clinical trials. Despite tremendous improvements in overall survival, patterns of response and progression to ICIs may be distinct from those traditionally described with classical chemotherapy or molecularly targeted therapies. In this context, pseudoprogression is observed in patients treated with ICIs that show response after a transient increase in tumor burden and hyperprogression is described as rapid radiological or clinical progression after immunotherapy. Most importantly, the assessment of radiological response in patients receiving ICIs needs to be differentiated. In this review, we aim to describe radiologic criteria for immune response evaluation and illustrate the newly reported concepts of atypical patterns of response to ICIs.