未经证实:在免疫治疗中区分假性进展和真实进展仍然是一个临床挑战。目前缺乏辅助这项任务的临床工具。DNA错配修复(MMR)状态是抗程序性死亡(PD)-1治疗的已知预测标记,但是它在帮助解决这种情况方面的作用并不明确。
未经评估:我们报告了第一个病例,根据我们的知识,危及生命的过度进展,后来被发现是MMR缺陷(dMMR)肿瘤患者的假性进展。我们描述了一名62岁的晚期dMMR胃癌患者,他正在接受pembrolizumab单药治疗。在三次剂量的pembrolizumab后,他表现出符合急性危及生命的胃肠道出血的所有适用的超进展定义的体征和症状。转移的广泛影像学进展,和增加癌胚抗原(CEA)。考虑到超进展的出现,考虑了舒适措施。但部分考虑到病人的要求,提供了积极的支持,包括血液制品,血管升压药,和脾动脉栓塞。他的病情好转了,随后的扫描显示他的转移消退和CEA下降,确认假进展。Pembrolizumab重新启动。一年多后,患者仍服用帕博利珠单抗,肿瘤负担最小。
UNASSIGNED:该病例表明危及生命的超进展可以代表假性进展,并提示MMR状态在确定明显超进展期间的临床管理积极性时可能是重要的考虑因素。
UNASSIGNED: Distinguishing pseudo-progression from true progression on immunotherapy remains a clinical challenge. Clinical tools to aid in this task are currently lacking. DNA mismatch repair (MMR) status is a known predictive marker for anti-programmed death (PD)-1 therapy, but its role in helping to address this situation is not well-defined.
UNASSIGNED: We report the first
case, to our knowledge, of life-threatening hyper-progression which was later revealed to be pseudo-progression in a patient with a deficient MMR (dMMR) tumor. We describe a 62-year-old man with advanced dMMR gastric cancer who was being treated with pembrolizumab monotherapy. After three doses of pembrolizumab he exhibited signs and symptoms that met all applicable definitions of hyper-progression in the setting of acute life-threatening gastrointestinal hemorrhage, extensive radiographic progression of metastases, and increasing carcinoembryonic antigen (CEA). Comfort measures were considered given the appearance of hyper-progression. But partly given the patient\'s request, aggressive support was provided, including blood products, vasopressors, and splenic artery embolization. His condition improved, and subsequent scans revealed regression of his metastases and decreased CEA, confirming pseudo-progression. Pembrolizumab was restarted. The patient remains on pembrolizumab with minimal tumor burden more than one year later.
UNASSIGNED: This
case demonstrates that life-threatening hyper-progression can represent pseudo-progression and suggests that MMR status could be important to consider in determining the aggressiveness of clinical management during apparent hyper-progression.