Pushing the limits of immune-related response: a case of “extreme pseudoprogression”

We describe a case of pseudoprogression that pushes the limits of immune-related response criteria and challenges the boundaries and definitions set by trial protocols. A middle-aged man with conventional clear cell renal cell carcinoma (RCC) had received multiple prior systemic treatments including vascular endothelial growth factor receptor tyrosine kinase inhibitors, as well as multiple surgeries and radiotherapy treatments. He was eventually started on nivolumab —the anti-programmed death receptor-1 monoclonal antibody approved for the treatment of advanced RCC. Clinical deterioration was observed soon after a 100 mg dose of nivolumab, with onset of acute renal failure and declining performance status. Radiologic progression was documented in multiple si tes including worsening tumor infiltration of his residual kidney. The patient was on palliative treatment and visited by the home hospice team in an end-of-life situation. The patient unexpectedly improved and went on to achieve a durable tumor response. The case is illustrative of an extreme manif estation of pseudoprogression, and impels us to probe the assumptions and controversies surrounding this phenomenon.
Source: Cancer Immunology, Immunotherapy - Category: Cancer & Oncology Source Type: research

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Authors: Hoffmann TK PMID: 32060569 [PubMed - as supplied by publisher]
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