Purpose: With the widespread use of immunotherapy agents, we encounter treatment responses such as hyperprogression disease (HPD) that we have not seen with previous standard chemotherapy and targeted therapies. It is known that survival in patients with HPD is shorter than in patients without HPD. Therefore, it is important to know the factors that will predict HPD. We aimed to identify HPD-related factors in patients treated with immunotherapy. Methods: A total of 121 adult metastatic cancer patients treated with immunotherapy for any cancer were included. Baseline demographics, the ECOG performance status, type of tumors and baseline blood count parameters were recorded. Possible predisposing factors were evaluated with univariate and multivariate analyses. Results: The median age was 62.28 (interquartile range (IQR) 54.02−67.63) years, and the median follow-up was 12.26 (IQR 5.6−24.36) months. Renal cell carcinoma (33%) and melanoma (33.8%) were the most common diagnoses. Twenty patients (16.5%) had HPD. A high LDH level (p: 0.001), hypoalbuminemia (p: 0.016) and an NLR > 5 (p: 0.007) were found to be associated with hyperprogression. Sex (female vs. male, p: 0.114), age (>65 vs. <65, p: 0.772), ECOG (0 vs. 1−4, p: 0.480) and the line of treatment (1−5, p: 0.112) were not found to be associated with hyperprogression. Conclusions: In this study, we observed HPD in 16.5% of immunotherapy-treated patients and increased HPD risk in patients with a high LDH level (p: 0.001), hypoalbuminemia (p: 0.016) and an NLR > 5 (p: 0.007).
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| http://dx.doi.org/10.3390/jcm11175171 | DOI Listing |
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Article Synopsis
- Monotherapy with anti-PD-1 monoclonal antibodies has been approved for treating advanced non-small cell lung cancer with positive PD-L1 expression, showing better survival rates than chemotherapy.
- Certain patients experience hyperprogressive disease (HPD) despite this treatment, a phenomenon where cancer progresses rapidly, but the reasons and molecular traits behind it remain unclear.
- This study presents two cases of advanced lung adenocarcinoma with HER2 exon 20 insertion that developed HPD after anti-PD-1 treatment, suggesting this mutation could serve as a biomarker for avoiding ineffective immunotherapy in specific patients.
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