Exploratory analysis of factors associated with hyperprogression in advanced non-small cell lung cancer (NSCLC) treated with PD1/PDL1 inhibitors.
Decatris, Marios Thomas, Joy Hayes, Mark Ryan, Philip Phillips, Aled ElBatrawy, Sherouk Bowden, Caitlin Du Rand, Ingrid
Decatris, Marios
Thomas, Joy
Hayes, Mark
Ryan, Philip
Phillips, Aled
ElBatrawy, Sherouk
Bowden, Caitlin
Du Rand, Ingrid
Glos Author
Date
2020-05-25
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Abstract
Background: Hyperprogressive disease(HPD) is a recently recognized type of accelerated tumor progression with immune checkpoint inhibitor(ICI) therapy. A recent meta-analysis identified serum lactate dehydrogenase(LDH) above upper limit of normal(ULN), liver metastases and > 2 metastatic sites to be associated with increased likelihood of HPD.
Methods: We performed a single-center retrospective analysis of NSCLC patients treated with ICI from 2/2017-1/2020. We defined HPD using combined criteria of failure to complete > 4 cycles of ICI and radiological progression with development of new lesions or marked clinical progression where restaging was not achievable because of rapid decline in performance status. Treatment discontinuation/interruption because of toxicity alone, was not designated as HPD.
Results: HPD was seen in 9/41(22%) patients treated with at least 1 cycle of ICI. In 6/9 there was marked radiological progression (new lesions/significant progression of existing lesions); in the remaining 3 restaging was not possible because of rapid decline which mandated treatment cessation. Patients with HPD were more likely to have a raised LDH, liver metastases or > 2 metastatic sites but these differences were not statistically significant. 9/9 versus 5/32 patients in the HPD/non-HPD cohorts respectively progressed within 10 weeks of treatment (p < 0.001) and 7/9 versus 12/32 respectively did not survive beyond 6 months (p = 0.057).
Conclusions: This small study has shown a non-statistically significant trend for association between HPD, raised LDH, liver metastases and presence of > 2 metastatic sites. A better understanding of risk/predictive factors for HPD is essential for improved patient selection for treatment with ICI.
Citation
Decatris, M. P., et al. (2020). Exploratory analysis of factors associated with hyperprogression in advanced non-small cell lung cancer (NSCLC) treated with PD1/PDL1 inhibitors. Journal of Clinical Oncology, 38(15_suppl), e21634–e21634. https://doi.org/10.1200/JCO.2020.38.15_suppl.e21634