Curative effect assessment of immunotherapy for non‐small cell lung cancer: The “blind area” of Immune Response Evaluation Criteria in Solid Tumors (iRECIST)

Abstract

Background Immunotherapy has considerably changed the treatment of lung cancer. As immunotherapy has a special mechanism of action, the disease remission that it can induce is unique. Recently, Immune Response Evaluation Criteria in Solid Tumors (iRECIST), which focus on assessing the apparent curative effect of immunotherapy, have become widely accepted. Based on iRECIST criteria, if the response to immunotherapy is determined to be immunity‐confirmed progressive disease or immunity‐unconfirmed progressive disease, and the Eastern Cooperative Oncology Group score is worse than before treatment, immunotherapy should be discontinued. We report two immunity‐confirmed progressive disease cases after pembrolizumab treatment and one immunity‐unconfirmed progressive disease case after nivolumab treatment. All three patients benefited from continued immunotherapy, which indicates that the iRECIST criteria may have limitations in assessing the efficacy of immunotherapy for non‐small cell lung cancer patients.

Radiomics, Tumor Volume, and Blood Biomarkers for Early Prediction of Pseudoprogression in Patients with Metastatic Melanoma Treated with Immune Checkpoint Inhibition

“…An explanation might be that mixed PP&TPD-patients could have had a slowly developing and/or resolving pseudoprogression of lesions that were still classified as PD at 6 months. Some studies described continued benefit from immunotherapy, despite confirmed progression according to iRECIST criteria (40)(41)(42)(43). It could therefore be possible that some lesions that were defined as confirmed progression in our analysis may respond much later during treatment, as these delayed tumor response dynamics have been described for both melanoma and NSCLC patients by Nishino et al (43,44) and Hodi et al (39).…”

Imaging Biomarkers to Predict and Evaluate the Effectiveness of Immunotherapy in Advanced Non-Small-Cell Lung Cancer

“…The approach involves manually measuring changes in size of target lesions between baseline and follow-up CT scans in conjunction with RECIST guidelines (33,37). Unfortunately, pure morphological criteria, even with modifications and refinements (i.e., iRECIST), are not sufficient because they only provide a consistent standard for management of data collected in clinical trials rather than clinical practice or therapy decisions (35,(38)(39)(40)(41). Owing to its distinctive biologic mechanisms of action, immunotherapy can generate a tumor response pattern different from those found with cytotoxic chemotherapy or radiation therapy (42).…”

Effective neoadjuvant immunotherapy and chemotherapy in stage IIIA adenosquamous carcinoma of the lung with a complete response and surgical success: A case report

“…Currently, there is a lack of standardized guidelines for assessing the efficacy of adjuvant therapy in lung adenocarcinoma. However, several scholars have argued that pathological assessment can effectively reflect clinical efficacy (23). After two cycles of treatment, the patient's response was assessed as stable disease, while postoperative pathology results confirmed the success of complete resection (R0).…”