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Comparison of Radiological Tumor Response Based on iRECIST and RECIST 1.1 in Metastatic Clear-Cell Rena Cell Carcinoma Patients Treated with Programmed Cell Death-1 Inhibitor Therapy

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Abstract
Objective: To evaluate the radiological tumor response patterns and compare the response assessments based on immune-based therapeutics Response Evaluation Criteria in Solid Tumors (iRECIST) and RECIST 1.1 in metastatic clear-cell renal cell carcinoma (mccRCC) patients treated with programmed cell death-1 (PD-1) inhibitors.

Materials and Methods: All mccRCC patients treated with PD-1 inhibitors at Henan Cancer Hospital, China, between January 2018 and April 2019, were retrospectively studied. A total of 30 mccRCC patients (20 males and 10 females; mean age, 55.6 years; age range, 37-79 years) were analyzed. The target lesions were quantified on consecutive CT scans during therapy using iRECIST and RECIST 1.1. The tumor growth rate was calculated before and after therapy initiation. The response patterns were analyzed, and the differences in tumor response assessments of the two criteria were compared. The intra- and inter-observer variabilities of iRECIST and RECIST 1.1 were also analyzed.

Results: The objective response rate throughout therapy was 50% (95% confidence interval [CI]: 32.1-67.9) based on iRECIST and 30% (95% CI: 13.6-46.4) based on RECIST 1.1. The time-to-progression (TTP) based on iRECIST was longer than that based on RECIST 1.1 (median TTP: not reached vs. 170 days, p = 0.04). iRECIST and RECIST 1.1 were discordant in 8 cases, which were evaluated as immune-unconfirmed PD based on iRECIST and PD based on RECIST 1.1. Six patients (20')/0, 6/30) had pseudoprogression based on iRECIST, of which four demonstrated early pseudoprogression and two had delayed pseudoprogression. Significant differences in the tumor response assessments based on the two criteria were observed (p < 0.001). No patients demonstrated hyperprogression during the study period.

Conclusion: Our study confirmed that the iRECIST criteria are more capable of capturing immune-related atypical responses during immunotherapy, whereas conventional RECIST 1.1 may underestimate the benefit of PD-1 inhibitors. Pseudoprogression is not rare in mccRCC patients during PD-1 inhibitor therapy, and it may last for more than the recommended maximum of 8 weeks, indicating a limitation of the current strategy for immune response monitoring.
Author(s)
신지훈Bingjie ZhengHailiang LiMeiyun WangYanqiong ChenYuan Guo
Issued Date
2021
Type
Article
Keyword
Clear cell renal cell carcinomaImmune-checkpoint inhibitorPD-1Tumor responseiRECIST criteria방사선과학
DOI
10.3348/kjr.2020.0404
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7796
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_nrf_kci_oai_kci_go_kr_ARTI_9738698&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Comparison%20of%20Radiological%20Tumor%20Response%20Based%20on%20iRECIST%20and%20RECIST%201.1%20in%20Metastatic%20Clear-Cell%20Rena%20Cell%20Carcinoma%20Patients%20Treated%20with%20Programmed%20Cell%20Death-1%20Inhibitor%20Therapy&amp;offset=0&amp;pcAvailability=true
Publisher
KOREAN JOURNAL OF RADIOLOGY
Location
대한민국
Language
영어
ISSN
1229-6929
Citation Volume
22
Citation Number
3
Citation Start Page
366
Citation End Page
375
Appears in Collections:
Medicine > Medicine
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