文章：

评估实体瘤对免疫治疗反应的挑战

Challenges in assessing solid tumor responses to immunotherapy 

原文发布日期：2019-12-11 

英文摘要：

With the advent of immunotherapy as an integral component of multidisciplinary solid tumor treatment, we are confronted by an unfamiliar and novel pattern of radiographic responses to treatment. Enlargement of tumors or even new lesions may not represent progression, but rather reflect what will ultimately evolve into a clinically beneficial response. In addition, the kinetics of radiographic changes in response to immunotherapy treatments may be distinct from what has been observed with cytotoxic chemotherapy and radiation. The phenomenon of pseudoprogression has been documented in patients receiving immunotherapeutic agents, such as checkpoint inhibitors and cellular therapies. Currently, there are no clinical response guidelines that adequately account for pseudoprogression and solid tumor responses to immunotherapy in general. Even so, response criteria have evolved to account for the radiographic manifestations of novel therapies. The evolution of World Health Organization (WHO) criteria and Response Evaluation Criteria in Solid Tumors (RECIST), along with the emergence of immune-related response criteria (irRC) and the immune Response Evaluation Criteria in Solid Tumors (iRECIST) reflect the need for new frameworks. This review evaluates the relationship between pseudoprogression, clinical outcomes, and our current understanding of the biology of pseudoprogression. To achieve our goal, we discuss unusual response patterns in patients receiving immunotherapy. We seek to develop a deeper understanding of radiographic responses to immunotherapy such that clinical benefit is not underappreciated in individual patients and during clinical investigation. 

摘要翻译： 

随着免疫疗法成为实体瘤多学科综合治疗的重要组成部分，我们面临着一种陌生而新颖的影像学治疗反应模式。肿瘤增大甚至出现新病灶可能并非疾病进展，而最终会演变为具有临床获益的治疗反应。此外，免疫治疗引发的影像学变化动力学特征可能不同于细胞毒性化疗和放疗中观察到的模式。假性进展现象在接受免疫检查点抑制剂和细胞疗法等免疫治疗的患者中已有记载。目前尚无临床反应指南能充分解释假性进展及实体瘤对免疫治疗的整体反应。尽管如此，为适应新型疗法的影像学表现，疗效评估标准已不断演进——世界卫生组织（WHO）标准与实体瘤疗效评价标准（RECIST）的更新，以及免疫相关反应标准（irRC）和免疫实体瘤疗效评价标准（iRECIST）的出现，均反映出对新评估框架的需求。本文综述旨在评估假性进展与临床结局之间的关系，以及我们目前对假性进展生物学机制的理解。通过探讨接受免疫治疗患者的不典型反应模式，力求深化对免疫治疗影像学反应的认识，避免在个体化诊疗和临床研究中低估其临床获益。

原文链接：

Challenges in assessing solid tumor responses to immunotherapy