Well‐controlled pleural effusion indicated pseudoprogression after immunotherapy in lung cancer: A case report

Liu, Guihong; Chen, Tao; Li, Ronghui; Zhu, Li; Liu, Dingyi; Ding, Zhenyu

doi:10.1111/1759-7714.12799

Cited by 11 publications

(3 citation statements)

References 25 publications

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“…The clinical course and characteristics of PE for patients in the αPD-1 group of the present study suggest that the activation of T lymphocytes by such therapy might lead to an immune-related reaction that is occasionally followed by clinical tumor shrinkage. Case reports have described emergence of PE followed by clinical benefit during αPD-1 therapy [22][23][24]. Our observational study confirms the existence of such patients.…”

Section: Discussionsupporting

confidence: 84%

Immune checkpoint protein and cytokine expression by T lymphocytes in pleural effusion of cancer patients receiving anti–PD-1 therapy

et al. 2019

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Pleural effusion (PE) occasionally develops in cancer patients during treatment with antibodies to programmed cell death-1 (PD-1) or to its ligand PD-L1 (hereafter, αPD-1 therapy). Such effusion often contains infiltrated mononuclear cells, although the types of immune cell present as well as the outcome of such patients have remained unclear. Materials and methods: We performed a multi-institutional, observational study to examine the clinical outcome of patients who develop PE after the onset of αPD-1 therapy. We compared the immune cell profiles and the immune status of lymphocytes in PE as determined by flow cytometry between nine patients who developed effusion during αPD-1 therapy (αPD-1 group) and 15 patients who developed PE during treatment with other anticancer agents (control group). Results: Most mononuclear cells in PE were lymphocytes in both the αPD-1 and control groups. The frequency of both CD4 + and CD8 + T lymphocytes expressing the immune checkpoint proteins TIM-3 or TIGIT as well as that of CD8 + T lymphocytes expressing PD-L1 were increased in the αPD-1 group compared with the control group. αPD-1 therapy continued for a substantial period after the emergence of PE in six of the nine patients in the αPD-1 group, and the frequency of CD4 + T lymphocytes in PE expressing the immune checkpoint protein LAG-3 or the cytokine interkeukin-17 was lower for these patients than for those who did not receive a sustained treatment benefit. Conclusion: Our results suggest a clinical benefit of continuing αPD-1 therapy in some patients who develop PE. We found that infiltrating T lymphocytes in PE manifest a more exhausted phenotype during αPD-1 therapy than during treatment with other cancer drugs, with subpopulations of these cells characterized by specific immune checkpoint protein and cytokine expression profiles possibly contributing to the antitumor immune response.

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Section: Discussionsupporting

confidence: 84%

Immune checkpoint protein and cytokine expression by T lymphocytes in pleural effusion of cancer patients receiving anti–PD-1 therapy

et al. 2019

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“…Pseudoprogression, which is defined as initial tumor growth followed by subsequent tumor regression, has been described with immunotherapy . However, it has not been sufficiently investigated as many studies have focused mainly on efficacy, as the number of patients using an immune checkpoint inhibitor has increased dramatically.…”

Section: Discussionmentioning

confidence: 99%

Pleural or pericardial metastasis: A significant factor affecting efficacy and adverse events in lung cancer patients treated with PD‐1/PD‐L1 inhibitors

Kang¹,

Chung²,

Kim

et al. 2018

Thoracic Cancer

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BackgroundImmunotherapy is a new paradigm for the treatment of non‐small‐cell lung cancer (NSCLC), and targeting the PD‐1 or PD‐L1 pathway is a promising therapeutic option. Although PD‐1/PD‐L1 inhibitors are more effective than standard chemotherapy in lung cancer, clinicians are afraid to actively use them because of hyperprogression and pseudoprogression. The aim of this study was to investigate the factors associated with tumor response and serious outcomes.MethodsWe retrospectively collected the medical records of 51 patients with advanced NSCLC who received PD‐1/PD‐L1 inhibitors between January 2016 and February 2018.ResultsThe mean patient age was 63.9 years, and 72.5% (37/51) were male. Most (92.2%, 47/51) had received previous systemic treatment. The overall response rate was 21.6% (11/51). The response rate was significantly lower in patients with pleural or pericardial metastasis than in patients without pleural or pericardial metastasis (4.3% vs. 35.7%; P = 0.007). Patients with pleural or pericardial metastasis had a significantly higher rate of adverse events of any grade (91.3% vs. 50.0%; P = 0.002) and grade 3–5 adverse events (52.2% vs. 25.0%; P = 0.046).ConclusionPleural or pericardial metastasis is a significant factor affecting the efficacy and rate of adverse events in advanced NSCLC patients treated with PD‐1/PD‐L1 inhibitors. Clinicians should pay attention to the use of immune checkpoint inhibitors in lung cancer patients with pleural or pericardial metastasis.

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“…Recurrence of, or an increase in, avidity on 18 F-FDG PET-CT most likely represents real disease progression in cases of true metastasis. However, there are reported cases in NSCLC whereby tumor response was preceded by apparent progression on imaging [19][20][21][22][23]. Pseudoprogression is likely due to inflammatory infiltration associated with immunotherapeutic agents [24], and it is usually noted during early stages of treatment.…”

Section: Discussionmentioning

confidence: 99%

A Multimodal Approach to Evaluate for Cardiac Metastasis in a Case of Non-Small Cell Lung Cancer

et al. 2020

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Malignancies have demonstrated the ability to metastasize to cardiac tissue. However, an optimal diagnostic algorithm for cardiac tumors has not yet been established, due at least in part to the scarcity of symptomatic cases. Several case reports describe how the usage of 18 F-labeled fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) incidentally revealed cardiac neoplasia. This modality, which indicates uptake sites of the radioisotope 18 F-FDG, allows for whole-body imaging and is often used for preoperative determination of malignant metastasis or for assessing response to therapy over time. However, findings of false positivity are often reported due to increased FDG avidity caused by a range of other, nonmetastatic processes, most notably inflammation and infection. In this case report, an 84-year-old male with stage IV non-small cell lung cancer presented a clinical course, echocardiogram, and 18 F-FDG PET-CT findings that were suggestive of endocardial metastasis. Nine months into therapy, after extensive consultation, the patient finally consented to a more complete workup using cardiac MRI (CMRI), which showed no evidence of cardiac metastasis. This case report supports the utility of CMRI as a means of further interpreting intracardiac, localized FDG uptake foci in PET-CT findings, in order to avoid false positivity and further refine proposed cardiac differential diagnoses in cancer patients.

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Well‐controlled pleural effusion indicated pseudoprogression after immunotherapy in lung cancer: A case report

Cited by 11 publications

References 25 publications

Immune checkpoint protein and cytokine expression by T lymphocytes in pleural effusion of cancer patients receiving anti–PD-1 therapy

Immune checkpoint protein and cytokine expression by T lymphocytes in pleural effusion of cancer patients receiving anti–PD-1 therapy

Pleural or pericardial metastasis: A significant factor affecting efficacy and adverse events in lung cancer patients treated with PD‐1/PD‐L1 inhibitors

A Multimodal Approach to Evaluate for Cardiac Metastasis in a Case of Non-Small Cell Lung Cancer

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