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Fan M, Yao J, Zhao Z, Zhang X, Lu J. Application of 99mTc-Labeled WL12 Peptides as a Tumor PD-L1-Targeted SPECT Imaging Agent: Kit Formulation, Preclinical Evaluation, and Study on the Influence of Coligands. Pharmaceuticals (Basel) 2024; 17:906. [PMID: 39065756 PMCID: PMC11279916 DOI: 10.3390/ph17070906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
With the development of PD-1/PD-L1 immune checkpoint inhibitor therapy, the ability to monitor PD-L1 expression in the tumor microenvironment is important for guiding therapy. This study was performed to develop a novel radiotracer with optimal pharmacokinetic properties to reflect PD-L1 expression in vivo via single-photon emission computed tomography (SPECT) imaging. [99mTc]Tc-HYNIC-WL12-tricine/M (M = TPPTS, PDA, ISONIC, 4-PSA) complexes with high radiochemical purity (>97%) and suitable molar activity (from 100.5 GBq/μmol to 300 GBq/μmol) were prepared through a kit preparation process. All 99mTc-labeled HYNIC-WL12 radiotracers displayed good in vitro stability for 4 h. The affinity and specificity of the four radiotracers for PD-L1 were demonstrated both in vitro and in vivo. The results of biodistribution studies displayed that the pharmacokinetics of the 99mTc-HYNIC-conjugated radiotracers were significantly influenced by the coligands of the radiotracers. Among them, [99mTc]Tc-HYNIC-WL12-tricine/ISONIC exhibited the optimal pharmacokinetic properties (t1/2α = 8.55 min, t1/2β = 54.05 min), including the fastest clearance in nontarget tissues, highest tumor-to-background contrast (e.g., tumor-to-muscle ratio, tumor-to-blood ratio: 40.42 ± 1.59, 14.72 ± 2.77 at 4 h p.i., respectively), and the lowest estimated radiation absorbed dose, highlighting its potential as a clinical SPECT imaging probe for tumor PD-L1 detection.
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Affiliation(s)
- Mingxuan Fan
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, China; (M.F.)
| | - Jingjing Yao
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, China; (M.F.)
| | - Zuoquan Zhao
- Theranostics and Translational Research Center, Institute of Clinical Medicine, Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xianzhong Zhang
- Theranostics and Translational Research Center, Institute of Clinical Medicine, Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jie Lu
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, China; (M.F.)
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2
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Yeo SH, Yoon HJ, Kim I, Kim YJ, Lee Y, Cha YK, Bak SH. Predictions of PD-L1 Expression Based on CT Imaging Features in Lung Squamous Cell Carcinoma. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:394-408. [PMID: 38617847 PMCID: PMC11009139 DOI: 10.3348/jksr.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/21/2023] [Accepted: 08/10/2023] [Indexed: 04/16/2024]
Abstract
Purpose To develop models to predict programmed death ligand 1 (PD-L1) expression in pulmonary squamous cell carcinoma (SCC) using CT. Materials and Methods A total of 97 patients diagnosed with SCC who underwent PD-L1 expression assay were included in this study. We performed a CT analysis of the tumors using pretreatment CT images. Multiple logistic regression models were constructed to predict PD-L1 positivity in the total patient group and in the 40 advanced-stage (≥ stage IIIB) patients. The area under the receiver operating characteristic curve (AUC) was calculated for each model. Results For the total patient group, the AUC of the 'total significant features model' (tumor stage, tumor size, pleural nodularity, and lung metastasis) was 0.652, and that of the 'selected feature model' (pleural nodularity) was 0.556. For advanced-stage patients, the AUC of the 'selected feature model' (tumor size, pleural nodularity, pulmonary oligometastases, and absence of interstitial lung disease) was 0.897. Among these factors, pleural nodularity and pulmonary oligometastases had the highest odds ratios (8.78 and 16.35, respectively). Conclusion Our model could predict PD-L1 expression in patients with lung SCC, and pleural nodularity and pulmonary oligometastases were notable predictive CT features of PD-L1.
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Weng D, Guo R, Zhu Z, Gao Y, An R, Zhou X. Peptide-based PET imaging agent of tumor TIGIT expression. EJNMMI Res 2023; 13:38. [PMID: 37129788 PMCID: PMC10154443 DOI: 10.1186/s13550-023-00982-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 04/07/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Accumulating studies have demonstrated that elevated TIGIT expression in tumor microenvironment correlates with better therapeutic response to TIGIT-based immunotherapy in pre-clinical studies. Therefore, a non-invasive method to detect tumor TIGIT expression is crucial to predict the therapeutic effect. METHODS In this study, a peptide-based PET imaging agent, 68Ga-DOTA-DTBP-3, was developed to non-invasively detect TIGIT expression by micro-PET in tumor-bearing BALB/c mice. DTBP-3, a D-peptide comprising of 12 amino acids, was radiolabeled with 68Ga through a DOTA chelator. In vitro studies were performed to evaluate the affinity of 68Ga-DOTA-DTBP-3 to TIGIT and its stability in fetal bovine serum. In vivo studies were assessed by micro-PET, biodistribution, and immunohistochemistry on tumor-bearing BALB/c mice. RESULTS The in vitro studies showed the equilibrium dissociation constant of 68Ga-DOTA-DTBP-3 for TIGIT was 84.21 nM and its radiochemistry purity was 89.24 ± 1.82% in FBS at 4 h in room temperature. The results of micro-PET, biodistribution and immunohistochemistry studies indicated that 68Ga-DOTA-DTBP-3 could be specifically targeted in 4T1 tumor-bearing mice, with a highest uptake at 0.5 h. CONCLUSION 68Ga-DOTA-DTBP-3 holds potential for non-invasively detect tumor TIGIT expression and for timely assessment of the therapeutic effect of immune checkpoint blockade.
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Affiliation(s)
- Dinghu Weng
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
| | - Rong Guo
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430000, Hubei, China
| | - Ziyang Zhu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430000, Hubei, China
| | - Yu Gao
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430000, Hubei, China
| | - Rui An
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430000, Hubei, China
| | - Xiuman Zhou
- School of Pharmaceutical Sciences (Shenzhen), SunYat-Sen University, Shenzhen, 518107, Guangdong, China
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4
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68Ga-HBED-CC-WL-12 PET in Diagnosing and Differentiating Pancreatic Cancers in Murine Models. Pharmaceuticals (Basel) 2023; 16:ph16010080. [PMID: 36678577 PMCID: PMC9865957 DOI: 10.3390/ph16010080] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Positron emission tomography (PET) has been proven as an important technology to detect the expression of programmed death ligand 1 (PD-L1) non-invasively and in real time. As a PD-L1 inhibitor, small peptide WL12 has shown great potential in serving as a targeting molecule to guide PD-L1 blockade therapy in clinic. In this study, WL12 was modified with HBED-CC to label 68Ga in a modified procedure, and the biologic properties were evaluated in vitro and in vivo. 68Ga-HBED-CC-WL12 showed good stability in saline and can specifically target PD-L1-positive cells U87MG and PANC02. In PANC02-bearing mice, 68Ga-HBED-CC-WL12 showed fast permeation in subcutaneous tumors within 20 min (SUVmax 0.37) and was of higher uptake in 90 min (SUVmax 0.38). When compared with 18F-FDG, 68Ga-FAPI-04, and 68Ga-RGD, 68Ga-HBED-CC-WL12 also demonstrated great image quality and advantages in evaluating immune microenvironment. This study modified the 68Ga-labeling procedure of WL12 and obtained better biologic properties and further manifested the clinical potential of 68Ga-HBED-CC-WL12 for PET imaging and guiding for immunotherapy.
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5
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PET imaging of lung and pleural cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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6
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Findings on Chest CT Performed in the Emergency Department in Patients Receiving Immune Checkpoint Inhibitor Therapy: Single-Institution 8-Year Experience in 136 Patients. AJR Am J Roentgenol 2021; 217:613-622. [DOI: 10.2214/ajr.20.24758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Miller AR, Manser R. The knowns & unknowns of pulmonary toxicity following immune checkpoint inhibitor therapies: a narrative review. Transl Lung Cancer Res 2021; 10:2752-2765. [PMID: 34295675 PMCID: PMC8264318 DOI: 10.21037/tlcr-20-806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
Since their discovery immune checkpoint inhibitors (ICI) have dramatically changed the treatment landscape for many cancers. In addition to their efficacy they are generally well tolerated, however, they have led to a new range of immune-related adverse events (irAEs) including pneumonitis. While not the most frequently reported immune-related adverse event in the clinical trial setting, recent real-world data suggests a significantly higher rate of pneumonitis leading to treatment suspension or cessation. It also appears to disproportionately contribute to immune-related mortality, particularly with anti-PD-1/PD-L1 treatment. While indicators have emerged regarding risk factors, incomplete prospective recording of patient characteristics hampers strong conclusions. Presenting symptoms are non-specific and the differential diagnosis is broad, made more complex by concomitant treatment with traditional chemotherapy or radiotherapy. Radiological findings are diverse and inconsistent terminology makes comparison and more complete characterization difficult. Further, little is known about the role of baseline testing or surveillance for early detection of pneumonitis, or the real-world role of bronchoscopy or biopsy in assessment. Scant literature exists to direct these complex decisions, so treatment guidelines have been published based on expert consensus. Here we provide a narrative review of what is known about ICI pneumonitis and propose key questions to enhance our understanding into the future.
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Affiliation(s)
- Alistair R Miller
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Victoria, Australia.,Department of Internal Medicine, Peter MacCallum Cancer Centre, Victoria, Australia.,Department of Medicine, Monash Health, Monash University, Victoria, Australia
| | - Renee Manser
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Victoria, Australia.,Department of Internal Medicine, Peter MacCallum Cancer Centre, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
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8
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Imaging of Oncologic Treatment-Related Pneumonitis: A Focused Review on Emerging Issues of Immune Checkpoint Inhibitor Pneumonitis, From the AJR Special Series on Inflammation. AJR Am J Roentgenol 2021; 218:19-27. [PMID: 33594904 DOI: 10.2214/ajr.21.25454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Treatment-related pneumonitis represents a major challenge in oncology patients undergoing therapy, and imaging plays an essential role in detection, diagnosis, and monitoring of pneumonitis in these patients. Among various types of pneumonitis from different kinds of cancer treatments, immune checkpoint inhibitor (ICI)-related pneumonitis has been recognized as an important topic in the radiology and oncology communities since 2015, given the increasing clinical indications for ICI therapy in patients with cancer. Moreover, clinical applications of ICIs continue to advance rapidly with novel combination approaches, leading to further emerging challenges. This focused review describes the current knowledge about ICI pneumonitis and discusses several newly emerging issues involving recurrence and flare of ICI pneumonitis, as well as involving pneumonitis from new combination approaches including ICI with epidermal growth factor receptor (EGFR) inhibitors and ICI with radiotherapy. The article concludes with a summary of unmet needs in the care of patients with ICI pneumonitis as well as of future directions in the advancement of knowledge about ICI pneumonitis and patient care for ICI pneumonitis. Given the proven multifaceted value of imaging in ICI pneumonitis, radiologists will remain central in the ongoing multidisciplinary journey to further understand and overcome this challenging toxicity for patients with cancer.
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Parekh M, Donuru A, Balasubramanya R, Kapur S. Review of the Chest CT Differential Diagnosis of Ground-Glass Opacities in the COVID Era. Radiology 2020; 297:E289-E302. [PMID: 32633678 PMCID: PMC7350036 DOI: 10.1148/radiol.2020202504] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19), a recently emerged lower respiratory tract illness, has quickly become a pandemic. The purpose of this review is to discuss and differentiate typical imaging findings of COVID-19 from those of other diseases, which can appear similar in the first instance. The typical CT findings of COVID-19 are bilateral and peripheral predominant ground-glass opacities. As per the Fleischner Society consensus statement, CT is appropriate in certain scenarios, including for patients who are at risk for and/or develop clinical worsening. The probability that CT findings represent COVID-19, however, depends largely on the pretest probability of infection, which is in turn defined by community prevalence of infection. When the community prevalence of COVID-19 is low, a large gap exists between positive predictive values of chest CT versus those of reverse transcriptase polymerase chain reaction. This implies that with use of chest CT there are a large number of false-positive results. Imaging differentiation is important for management and isolation purposes and for appropriate disposition of patients with false-positive CT findings. Herein the authors discuss differential pathology with close imaging resemblance to typical CT imaging features of COVID-19 and highlight CT features that may help differentiate COVID-19 from other conditions.
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Affiliation(s)
- Maansi Parekh
- From the Department of Radiology, Thomas Jefferson University Hospitals, 132 S 10th St, 1079 Main Building, Philadelphia, PA 19107 (M.P., A.D., R.B.); and Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (S.K.)
| | - Achala Donuru
- From the Department of Radiology, Thomas Jefferson University Hospitals, 132 S 10th St, 1079 Main Building, Philadelphia, PA 19107 (M.P., A.D., R.B.); and Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (S.K.)
| | - Rashmi Balasubramanya
- From the Department of Radiology, Thomas Jefferson University Hospitals, 132 S 10th St, 1079 Main Building, Philadelphia, PA 19107 (M.P., A.D., R.B.); and Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (S.K.)
| | - Sangita Kapur
- From the Department of Radiology, Thomas Jefferson University Hospitals, 132 S 10th St, 1079 Main Building, Philadelphia, PA 19107 (M.P., A.D., R.B.); and Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (S.K.)
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Ezponda Casajús A, Calvo Imirizaldu M, de Torres Tajes J, García-Baizán A, Castañón Álvarez E, Cano Rafart D, Vivas Pérez I, Bastarrika Alemañ G. Immune-related adverse events as predictors of response in cancer patients undergoing immunotherapy. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Gorospe L, Pacios-Blanco RE, Garrido-López P. The Importance of Imaging Studies in the Assessment of Response to Immunotherapy in Lung Cancer. Arch Bronconeumol 2020; 56:380-389. [PMID: 31898993 DOI: 10.1016/j.arbres.2019.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/17/2022]
Abstract
Immunotherapy (particularly immune checkpoint inhibitors) in the treatment of patients with lung cancer has aroused great interest in recent years, revolutionized the management of patients with locally advanced/metastatic disease, and given hope to both patients and treating physicians. These drugs, in combination or in monotherapy, have become the standard treatment for many patients with lung cancer, and their use is expected to increase significantly in the near future. In this article, we will review the growing importance of imaging techniques in the evaluation of therapeutic response to immunotherapy in lung cancer patients, with emphasis on the new specific radiological criteria on response to immunotherapy, atypical radiological responses (pseudoprogresion, dissociative responses, hyperprogresion), and the main radiological manifestations of adverse events associated with immunotherapy (sarcoid reactions, pulmonary toxicities, etc.). Pulmonologists must be familiar not only with atypical radiological responses to immunotherapy and their prognostic implications, but also with their effects and the new radiological criteria of response to assess treatment response. In this study, we will address key concepts such as "pseudoprogresion", "paradoxical response", "hyperprogresion", or "unconfirmed progression", and their significance in the management of patients with lung cancer treated with immunotherapy.
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Affiliation(s)
- Luis Gorospe
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | - Pilar Garrido-López
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
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12
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Immune-related adverse events as predictors of response in cancer patients undergoing immunotherapy. RADIOLOGIA 2019; 62:131-138. [PMID: 31405549 DOI: 10.1016/j.rx.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/01/2019] [Accepted: 06/19/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the incidence of immune-mediated adverse reactions with and without radiologic manifestations and to correlate them with the response to immunotherapy. MATERIAL AND METHODS We retrospectively included 79 patients with stage IV lung carcinomas (n=24), renal carcinomas (n=11), or melanoma (n=44) treated with immunotherapy. We evaluated the occurrence of immune-mediated adverse reactions, their radiologic manifestations, and the response pattern according to the immune-related response criteria (irRC). We correlated the presence of immune-mediated adverse reactions with the response pattern. RESULTS Immune-mediated adverse reactions occurred in 27.8%, being most common in patients with melanoma (40.9%). In 59.1% of patients with adverse reactions, there were radiologic manifestations such as pneumonitis, colitis, hypophysitis, thyroiditis, or myocarditis. Pneumonitis was the most common radiologic manifestation of immune-mediated adverse reactions, even in asymptomatic patients. The rate of response to immunotherapy was higher among patients who developed immune-mediated adverse reactions than in those who did not (68.2% vs. 38.6%, respectively, χ2 5.58; p=0.018). The rate of favorable responses was higher in patients with radiologic manifestations of immune-mediated adverse reactions than in those without radiologic manifestations (84.6% vs. 44.4%, respectively; p=0.023). CONCLUSIONS The presence of immune-mediated adverse reactions is associated with a better response to immunotherapy. The association with a favorable response is even stronger in patients with radiologic manifestations of the immune-mediated adverse reactions.
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13
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Passler M, Taube ET, Sehouli J, Pietzner K. Pseudo- or real progression? An ovarian cancer patient under nivolumab: A case report. World J Clin Oncol 2019; 10:247-255. [PMID: 31396474 PMCID: PMC6682498 DOI: 10.5306/wjco.v10.i7.247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/03/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Checkpoint-Inhibition has revolutionized the treatment for several entities such as melanoma and renal cell carcinoma. The first encouraging experience in ovarian cancer was reported for nivolumab, a fully humanized anti-programmed death-1 antibody. Pseudoprogression is a new phenomenon associated with these novel immuno-oncologic agents. It can be explained by infiltrating leucocytes and edema that result in a temporary increase in tumor size and delayed subsequent shrinkage due to tumor cell destruction.
CASE SUMMARY We report on a 47-year old patient with platinum-resistant ovarian cancer that was treated off-label with nivolumab 3mg/kg iv d1q14d. She first experienced classic pseudoprogression with inguinal lymph node swelling after cycle two and subsequent shrinkage. After 6 cycles she presented with rectal bleeding and progressive disease was diagnosed due to new tumor infiltration into the rectum.
CONCLUSION Clinicians should be aware of pseudoprogression, its underlying mechanisms and strategies to discriminate pseudo- from real progression in ovarian cancer.
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Affiliation(s)
- Mona Passler
- Department of Gynecology, Competence Center for Ovarian Cancer (EKZE), Charité - University Medicine, Berlin 13353, Germany
| | - Eliane T Taube
- Institute of Pathology, Charité University Hospital, Berlin 10117, Germany
| | - Jalid Sehouli
- Department of Gynecology, Competence Center for Ovarian Cancer (EKZE), Charité - University Medicine, Berlin 13353, Germany
| | - Klaus Pietzner
- Department of Gynecology, Competence Center for Ovarian Cancer (EKZE), Charité - University Medicine, Berlin 13353, Germany
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Yang J, He X, Lv Q, Jing J, Shi H. Management of Adverse Events in Cancer Patients Treated With PD-1/PD-L1 Blockade: Focus on Asian Populations. Front Pharmacol 2019; 10:726. [PMID: 31312140 PMCID: PMC6614522 DOI: 10.3389/fphar.2019.00726] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/05/2019] [Indexed: 02/05/2023] Open
Abstract
The interaction between programmed cell death protein 1 (PD-1) and its ligand programmed death-ligand 1 (PD-L1) induces exhaustions of cytotoxic lymphocytes in the tumor microenvironment, which facilitates tumor immune evasion. PD-1/PD-L1 blockade therapy, which prevents the receptors and ligands from binding to each other, disrupts the T-cell exhaustion signaling, thereby increasing antitumor immunity. Inspiringly, it has revolutionized the treatment of many different types of cancers including non-small-cell lung carcinoma, melanoma, lymphoma, and so on. However, with the intention of generating an antitumor immune response, PD-1/PD-L1 blockade may also lead to a spectrum of side effects. The profile of adverse events (AEs) of PD-1/PD-L1 blockade is not exactly the same with other immune checkpoint blockades, such as blockade of cytotoxic T-lymphocyte-associated protein 4. Although cutaneous, gastrointestinal, and pulmonary systems are common victims, AEs of PD-1/PD-L1 blockade might occur in any other organ system of the human body. These toxicities can be life-threatening if not managed promptly, and proper treatment intervention is imperative for optimal control and prevention of severe damage. Currently, clinical practice for the management of AEs in PD-1/PD-L1 blockade remains sporadic and variable. The majority of initial clinical trials were carried out in Caucasians. The trials of multiple races usually included a small portion of Asian participants, and results were calculated and interpreted for the entire included subjects without any race-specific conclusions. Therefore, the information on PD-1/PD-L1 blockade in Asians is far from systematic or comprehensive. Recently, as the results of clinical trials of anti-PD-1/PD-L1 agents in Asian populations have been gradually released, we summarized current evidence with a specific focus on the Asian population, hoping to outline strategies and offer guidance on the management of AEs in cancer patients treated with PD-1/PD-L1 blockade in the Asian world.
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Affiliation(s)
- Jiqiao Yang
- Laboratory of Tumor Targeted and Immune Therapy, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiujing He
- Laboratory of Tumor Targeted and Immune Therapy, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Lv
- Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Jing
- Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Hubing Shi
- Laboratory of Tumor Targeted and Immune Therapy, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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15
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Bustos Fiore A, Banguero Gutiérrez A, Guerrero Acosta L, Segura Cros C, Ramos de la Rosa R. Immunotherapy in oncology: A new challenge for radiologists. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Hao L, Zhang J, Di Y, Tan Z. Prognostic Value of White Blood Cells Detected for the First Time After Adjuvant Chemotherapy in Primary Operable Non-Small Cell Lung Cancer. Technol Cancer Res Treat 2019; 17:1533033818802813. [PMID: 30295143 PMCID: PMC6176539 DOI: 10.1177/1533033818802813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate the prognostic value of white blood cells detected for the first time after adjuvant chemotherapy in primary operable non-small cell lung cancer. METHODS From January 2010 to May 2016, data from 208 patients who underwent surgery for non-small cell lung cancer were retrospectively analyzed. RESULTS A white blood cell count detected for the first time after adjuvant chemotherapy greater than 7.00 was an independent predictor of poor disease-free survival (Hazard ratio: 1.736, 95% confidence interval: 1.267-2.378; P = .001) and overall survival (Hazard ratio: 1.802, 95% confidence interval: 1.305-2.471; P = .000). In a further study, after myelosuppression, survival analysis indicated that the patients with white blood cell counts <2.5 had poorer survival than patients with blood cell counts 2.5 to 4.0, P = .031. When the analysis was stratified by the type of histology, patients with a white blood cell count >7.00 and increased white blood cell after chemotherapy compared to pretreatment had a poorer prognosis than patients with white blood cell ≤7.00 and no increase in white blood cell, P = .000 and P = .002, respectively. We further evaluated the prognosis of the 2 groups in different levels of white blood cell. In the group of patients with white blood cell ≤4.0, patients with chemotherapy cycles ≤2, and >2 showed no differences (Hazard ratio: 2.346, 95% confidence interval: 0.288-19.073, P = .425). In the group of patients with white blood cell of 4.0 to 7.0, the prognosis of patients with chemotherapy cycles ≤2 and patients with chemotherapy cycles >2 showed no difference (Hazard ratio: 0.560, 95% confidence interval: 0.248-1.261, P = .161). In the group of patients with white blood cell >7.0, patients with >2 chemotherapy cycles had a better prognosis than patients with chemotherapy cycles ≤2 (Hazard ratio: 0.573, 95% confidence interval: 0.338-0.971, P = .037) Conclusions: The level of white blood cells detected for the first time after adjuvant chemotherapy is an independent risk factor for non-small cell lung cancer, especially for patients with nonadenocarcinoma. In addition, the level of white blood cells after postoperative adjuvant chemotherapy and its change compared with pretreatment might also provide useful information regarding the best choice of cycles of adjuvant chemotherapy.
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Affiliation(s)
- Ligang Hao
- 1 Department of Thoracic Surgery, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Junjie Zhang
- 2 Department of CT&MR, The First Hospital of Xingtai, Xingtai, Hebei, China
| | - Yonghui Di
- 1 Department of Thoracic Surgery, Xingtai People's Hospital, Xingtai, Hebei, China
| | - Zhenbo Tan
- 1 Department of Thoracic Surgery, Xingtai People's Hospital, Xingtai, Hebei, China
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17
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Bustos Fiore A, Gutiérrez AB, Acosta LG, Segura Cros C, Ramos de la Rosa R. Immunotherapy in oncology: a new challenge for radiologists. RADIOLOGIA 2018; 61:134-142. [PMID: 30580817 DOI: 10.1016/j.rx.2018.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/20/2018] [Accepted: 10/21/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In patients with oncologic disease, immunotherapy has become established as an alternative or complementary therapy to traditional treatment options (surgery, radiotherapy, and chemotherapy). Currently available immunotherapy modes can be divided into two types: passive and active. The active type strengthens the immune system's response to tumor cells by activating both humoral immunity and cell-mediated immunity, using the adaptive response. This article aims to analyze the radiologic patterns of the response to immunotherapy through immune-response-related criteria and to describe the main adverse effects associated with this treatment approach. CONCLUSION Imaging tests play a fundamental role in the follow-up of oncologic patients and in the assessment of their response to treatment. Immunotherapy represents a challenge for radiologists both in the evaluation of the response to immunotherapy and in the detection of the adverse effects associated with this treatment approach.
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Affiliation(s)
- A Bustos Fiore
- Hospital Universitario Quirón Dexeus, Barcelona, España.
| | | | | | - C Segura Cros
- Hospital Universitario Quirón Dexeus, Barcelona, España
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18
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De Silva RA, Kumar D, Lisok A, Chatterjee S, Wharram B, Venkateswara Rao K, Mease R, Dannals RF, Pomper MG, Nimmagadda S. Peptide-Based 68Ga-PET Radiotracer for Imaging PD-L1 Expression in Cancer. Mol Pharm 2018; 15:3946-3952. [PMID: 30037229 PMCID: PMC6127800 DOI: 10.1021/acs.molpharmaceut.8b00399] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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Tumors create and maintain an immunosuppressive
microenvironment
that promotes cancer cell escape from immune surveillance. The immune
checkpoint protein programmed death-ligand 1 (PD-L1) is expressed
in many cancers and is an important contributor to the maintenance
of the immunosuppressive tumor microenvironment. PD-L1 is a prominent
target for cancer immunotherapy. Guidance of anti-PD-L1 therapy is
currently effected through measurement of PD-L1 through biopsy and
immunohistochemistry. Here, we report a peptide-based imaging agent,
[68Ga]WL12, to detect PD-L1 expression in tumors noninvasively
by positron emission tomography (PET). WL12, a cyclic peptide comprising
14 amino acids, binds to PD-L1 with high affinity (IC50≈ 23
nM). Synthesis of [68Ga]WL12 provided radiochemical purity
>99% after purification. Biodistribution in immunocompetent mice
demonstrated
11.56 ± 3.18, 4.97 ± 0.8, 1.9 ± 0.1, and 1.33 ±
0.21 percentage of injected dose per gram (%ID/g) in hPD-L1, MDAMB231,
SUM149, and CHO tumors, respectively, at 1 h postinjection, with high
binding specificity noted with coinjection of excess, nonradiolabeled
WL12. PET imaging demonstrated high tissue contrast in all tumor models
tested.
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Affiliation(s)
- Ravindra A De Silva
- Russell H. Morgan Department of Radiology and Radiological Science , Sidney Kimmel Comprehensive Canter Center, Johns Hopkins University , Baltimore , Maryland 21287 , United States
| | - Dhiraj Kumar
- Russell H. Morgan Department of Radiology and Radiological Science , Sidney Kimmel Comprehensive Canter Center, Johns Hopkins University , Baltimore , Maryland 21287 , United States
| | - Ala Lisok
- Russell H. Morgan Department of Radiology and Radiological Science , Sidney Kimmel Comprehensive Canter Center, Johns Hopkins University , Baltimore , Maryland 21287 , United States
| | - Samit Chatterjee
- Russell H. Morgan Department of Radiology and Radiological Science , Sidney Kimmel Comprehensive Canter Center, Johns Hopkins University , Baltimore , Maryland 21287 , United States
| | - Bryan Wharram
- Russell H. Morgan Department of Radiology and Radiological Science , Sidney Kimmel Comprehensive Canter Center, Johns Hopkins University , Baltimore , Maryland 21287 , United States
| | - Kalagadda Venkateswara Rao
- Russell H. Morgan Department of Radiology and Radiological Science , Sidney Kimmel Comprehensive Canter Center, Johns Hopkins University , Baltimore , Maryland 21287 , United States
| | - Ronnie Mease
- Russell H. Morgan Department of Radiology and Radiological Science , Sidney Kimmel Comprehensive Canter Center, Johns Hopkins University , Baltimore , Maryland 21287 , United States
| | - Robert F Dannals
- Russell H. Morgan Department of Radiology and Radiological Science , Sidney Kimmel Comprehensive Canter Center, Johns Hopkins University , Baltimore , Maryland 21287 , United States
| | - Martin G Pomper
- Russell H. Morgan Department of Radiology and Radiological Science , Sidney Kimmel Comprehensive Canter Center, Johns Hopkins University , Baltimore , Maryland 21287 , United States
| | - Sridhar Nimmagadda
- Russell H. Morgan Department of Radiology and Radiological Science , Sidney Kimmel Comprehensive Canter Center, Johns Hopkins University , Baltimore , Maryland 21287 , United States
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19
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Wang GX, Kurra V, Gainor JF, Sullivan RJ, Flaherty KT, Lee SI, Fintelmann FJ. Immune Checkpoint Inhibitor Cancer Therapy: Spectrum of Imaging Findings. Radiographics 2018; 37:2132-2144. [PMID: 29131763 DOI: 10.1148/rg.2017170085] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Immune checkpoint inhibitors are a new class of cancer therapeutics that have demonstrated striking successes in a rapid series of clinical trials. Consequently, these drugs have dramatically increased in clinical use since being first approved for advanced melanoma in 2011. Current indications in addition to melanoma are non-small cell lung cancer, head and neck squamous cell carcinoma, renal cell carcinoma, urothelial carcinoma, and classical Hodgkin lymphoma. A small subset of patients treated with immune checkpoint inhibitors undergoes an atypical treatment response pattern termed pseudoprogression: New or enlarging lesions appear after initiation of therapy, thereby mimicking tumor progression, followed by an eventual decrease in total tumor burden. Traditional response standards applied at the time of initial increase in tumor burden can falsely designate this as treatment failure and could lead to inappropriate termination of therapy. Currently, when new or enlarging lesions are observed with immune checkpoint inhibitors, only follow-up imaging can help distinguish patients with pseudoprogression from the large majority in whom this observation represents true treatment failure. Furthermore, the unique mechanism of immune checkpoint inhibitors can cause a distinct set of adverse events related to autoimmunity, which can be severe or life threatening. Given the central role of imaging in cancer care, radiologists must be knowledgeable about immune checkpoint inhibitors to correctly assess treatment response and expeditiously diagnose treatment-related complications. The authors review the molecular mechanisms and clinical applications of immune checkpoint inhibitors, the current strategy to distinguish pseudoprogression from progression, and the imaging appearances of common immune-related adverse events. ©RSNA, 2017.
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Affiliation(s)
- Gary X Wang
- From the Departments of Radiology (G.X.W., V.K., S.I.L., F.J.F.) and Medicine (J.F.G., R.J.S., K.T.F.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders 210, Boston, MA 02114
| | - Vikram Kurra
- From the Departments of Radiology (G.X.W., V.K., S.I.L., F.J.F.) and Medicine (J.F.G., R.J.S., K.T.F.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders 210, Boston, MA 02114
| | - Justin F Gainor
- From the Departments of Radiology (G.X.W., V.K., S.I.L., F.J.F.) and Medicine (J.F.G., R.J.S., K.T.F.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders 210, Boston, MA 02114
| | - Ryan J Sullivan
- From the Departments of Radiology (G.X.W., V.K., S.I.L., F.J.F.) and Medicine (J.F.G., R.J.S., K.T.F.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders 210, Boston, MA 02114
| | - Keith T Flaherty
- From the Departments of Radiology (G.X.W., V.K., S.I.L., F.J.F.) and Medicine (J.F.G., R.J.S., K.T.F.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders 210, Boston, MA 02114
| | - Susanna I Lee
- From the Departments of Radiology (G.X.W., V.K., S.I.L., F.J.F.) and Medicine (J.F.G., R.J.S., K.T.F.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders 210, Boston, MA 02114
| | - Florian J Fintelmann
- From the Departments of Radiology (G.X.W., V.K., S.I.L., F.J.F.) and Medicine (J.F.G., R.J.S., K.T.F.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Founders 210, Boston, MA 02114
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20
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A Sarcoidlike Reaction Mimicking Metastatic Malignancy in a Patient With Melanoma Treated With Pembrolizumab. AJR Am J Roentgenol 2018; 210:W183-W184. [DOI: 10.2214/ajr.17.19144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Thoracic Imaging of Solid Tumor Patients Treated with Immune Checkpoint Inhibitors. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0269-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Sequential CT Findings in Patients With Non-small-cell Lung Cancer Receiving Nivolumab. Clin Lung Cancer 2017; 19:175-180. [PMID: 29153896 DOI: 10.1016/j.cllc.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nivolumab is a novel immunotherapy that was recently approved for treatment of advanced non-small-cell lung cancer (NSCLC). Patients treated with checkpoint inhibitors may show variable computed tomography (CT) features on follow-up imaging, and it is unclear how reliable conventional response criteria are to determine patient management and outcomes. We report the spectrum of sequential CT findings in patients with advanced stage lung cancer who received nivolumab in an effort to better inform appropriate imaging strategies. MATERIALS AND METHODS We identified all patients at our institution with advanced NSCLC who received nivolumab. Pre- and posttreatment CT scans were reviewed and categorized based on radiographic response to therapy. Demographic data as well as survival data were recorded. RESULTS There were 34 patients with advanced NSCLC who received nivolumab with sufficient follow-up data. Nineteen patients were classified as responders to treatment; 6 (32%) of 19 showed improvement on their initial follow-up CT and had an average survival of 11.2 months, whereas 13 (68%) of 19 responders initially had stable or progressive disease on CT with an average survival of 11.6 months. Fifteen patients were classified as nonresponders to treatment with an average survival of 3.4 months. CONCLUSION Novel immunotherapies such as nivolumab mechanistically differ from conventional chemotherapy. Some patients have improved survival despite initial radiographic progression of disease. Our findings underscore the heterogeneous radiographic appearance at follow-up CT in patients with lung cancer who ultimately respond to nivolumab.
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