Tumor Growth Rate Decline despite Progressive Disease May Predict Improved Nivolumab Treatment Outcome in mRCC: When RECIST Is Not Enough
Treatment response is usually assessed by the response evaluation criteria in solid tumors (RECIST). These criteria may not be adequate to evaluate the response to immunotherapy, considering the peculiar patterns of response reported with this therapy. With the advent of immunotherapy these criteria...
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doaj-23f1555bbb2641ac89ef9463b870a7472021-07-23T13:33:31ZengMDPI AGCancers2072-66942021-07-01133492349210.3390/cancers13143492Tumor Growth Rate Decline despite Progressive Disease May Predict Improved Nivolumab Treatment Outcome in mRCC: When RECIST Is Not EnoughVeronica Mollica0Stefano Brocchi1Filippo Gustavo Dall’Olio2Laura Marcolin3Alexandro Paccapelo4Matteo Santoni5Alessandro Rizzo6Rodolfo Montironi7Rita Golfieri8Francesco Massari9Andrea Ardizzoni10Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni n. 15, 40138 Bologna, ItalyDepartment of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, ItalyMedical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni n. 15, 40138 Bologna, ItalyDepartment of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, ItalyDepartment of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, ItalyOncology Unit, Macerata Hospital, 62100 Macerata, ItalyMedical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni n. 15, 40138 Bologna, ItalySection of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, 60126 Ancona, ItalyDepartment of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, ItalyMedical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni n. 15, 40138 Bologna, ItalyMedical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni n. 15, 40138 Bologna, ItalyTreatment response is usually assessed by the response evaluation criteria in solid tumors (RECIST). These criteria may not be adequate to evaluate the response to immunotherapy, considering the peculiar patterns of response reported with this therapy. With the advent of immunotherapy these criteria have been modified to include the evaluation of the peculiar responses seen with this type of therapy (iRECIST criteria), including pseudoprogressions and hyperprogressions. Tumor growth rate (TGR) is a dynamic evaluation that takes into account the kinetics of response to treatment and may help catch the real efficacy of an immunotherapy approach. We performed a retrospective monocentric study to explore the impact of TGR change after nivolumab administration as the second or later line of treatment in patients with metastatic renal cell carcinoma (RCC). We evaluated 27 patients, divided into three categories: Disease control (DC) if there was no PD; lower velocity PD (LvPD) if disease progressed but the TGR at second assessment (TGR2) was lower than the TGR at first assessment (TGR1); higher velocity PD (HvPD) if TGR2 was higher than TGR1. The median OS for the DC group was 11.0 months (95% CI 5.0–17.0) (reference) vs. (not reached) NR (95% CI NR-NR) for LvPD (HR 0.27; 95% CI 0.06–1.30; <i>p</i> 0.102) vs. NR (95% CI NR–NR) for HvPD (HR 0.23; 95% CI 0.06–0.88; <i>p</i> 0.032). There was no difference between LvPD and DC (HR 1.21; 95% CI 0.20–7.28; <i>p</i> 0.838). In patients with metastatic RCC, the second or later line of nivolumab treatment may lead to a deceleration in TGR resulting in an improved survival outcome similar to that observed in patients experiencing tumor regression. In this subgroup, especially in the presence of a clinical benefit, continuing the treatment beyond progression can be recommended.https://www.mdpi.com/2072-6694/13/14/3492renal cell carcinomaRCCnivolumabimmunotherapytumor growth rateTGR |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Veronica Mollica Stefano Brocchi Filippo Gustavo Dall’Olio Laura Marcolin Alexandro Paccapelo Matteo Santoni Alessandro Rizzo Rodolfo Montironi Rita Golfieri Francesco Massari Andrea Ardizzoni |
spellingShingle |
Veronica Mollica Stefano Brocchi Filippo Gustavo Dall’Olio Laura Marcolin Alexandro Paccapelo Matteo Santoni Alessandro Rizzo Rodolfo Montironi Rita Golfieri Francesco Massari Andrea Ardizzoni Tumor Growth Rate Decline despite Progressive Disease May Predict Improved Nivolumab Treatment Outcome in mRCC: When RECIST Is Not Enough Cancers renal cell carcinoma RCC nivolumab immunotherapy tumor growth rate TGR |
author_facet |
Veronica Mollica Stefano Brocchi Filippo Gustavo Dall’Olio Laura Marcolin Alexandro Paccapelo Matteo Santoni Alessandro Rizzo Rodolfo Montironi Rita Golfieri Francesco Massari Andrea Ardizzoni |
author_sort |
Veronica Mollica |
title |
Tumor Growth Rate Decline despite Progressive Disease May Predict Improved Nivolumab Treatment Outcome in mRCC: When RECIST Is Not Enough |
title_short |
Tumor Growth Rate Decline despite Progressive Disease May Predict Improved Nivolumab Treatment Outcome in mRCC: When RECIST Is Not Enough |
title_full |
Tumor Growth Rate Decline despite Progressive Disease May Predict Improved Nivolumab Treatment Outcome in mRCC: When RECIST Is Not Enough |
title_fullStr |
Tumor Growth Rate Decline despite Progressive Disease May Predict Improved Nivolumab Treatment Outcome in mRCC: When RECIST Is Not Enough |
title_full_unstemmed |
Tumor Growth Rate Decline despite Progressive Disease May Predict Improved Nivolumab Treatment Outcome in mRCC: When RECIST Is Not Enough |
title_sort |
tumor growth rate decline despite progressive disease may predict improved nivolumab treatment outcome in mrcc: when recist is not enough |
publisher |
MDPI AG |
series |
Cancers |
issn |
2072-6694 |
publishDate |
2021-07-01 |
description |
Treatment response is usually assessed by the response evaluation criteria in solid tumors (RECIST). These criteria may not be adequate to evaluate the response to immunotherapy, considering the peculiar patterns of response reported with this therapy. With the advent of immunotherapy these criteria have been modified to include the evaluation of the peculiar responses seen with this type of therapy (iRECIST criteria), including pseudoprogressions and hyperprogressions. Tumor growth rate (TGR) is a dynamic evaluation that takes into account the kinetics of response to treatment and may help catch the real efficacy of an immunotherapy approach. We performed a retrospective monocentric study to explore the impact of TGR change after nivolumab administration as the second or later line of treatment in patients with metastatic renal cell carcinoma (RCC). We evaluated 27 patients, divided into three categories: Disease control (DC) if there was no PD; lower velocity PD (LvPD) if disease progressed but the TGR at second assessment (TGR2) was lower than the TGR at first assessment (TGR1); higher velocity PD (HvPD) if TGR2 was higher than TGR1. The median OS for the DC group was 11.0 months (95% CI 5.0–17.0) (reference) vs. (not reached) NR (95% CI NR-NR) for LvPD (HR 0.27; 95% CI 0.06–1.30; <i>p</i> 0.102) vs. NR (95% CI NR–NR) for HvPD (HR 0.23; 95% CI 0.06–0.88; <i>p</i> 0.032). There was no difference between LvPD and DC (HR 1.21; 95% CI 0.20–7.28; <i>p</i> 0.838). In patients with metastatic RCC, the second or later line of nivolumab treatment may lead to a deceleration in TGR resulting in an improved survival outcome similar to that observed in patients experiencing tumor regression. In this subgroup, especially in the presence of a clinical benefit, continuing the treatment beyond progression can be recommended. |
topic |
renal cell carcinoma RCC nivolumab immunotherapy tumor growth rate TGR |
url |
https://www.mdpi.com/2072-6694/13/14/3492 |
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