Pseudo progression related scanning problems (articles and cases)
Posted: Sun Nov 20, 2016 5:12 pm
if you start one of the newer drugs like TKI, IFN, immunotherapies like vaccines or Immune checkpoint inhibitors (ICI) like Keytruda or Opdivo - you should read this article and discuss it with the radiologist and oncologist.
Cancer Immunotherapy: Imaging Assessment of Novel Treatment Response Patterns and Immune-related Adverse Events
http://pubs.rsna.org/doi/full/10.1148/rg.352140121
It is avail. in fill text and all people on the novel/non-traditional chemotherapy drugs should read it.
They say (I copy from there):
"Early clinical experience with recombinant cytokines, cancer vaccines, and immunomodulatory monoclonal antibodies has demonstrated a delayed response to treatment compared with that of cytotoxic chemotherapy, clinically significant disease stability, and transient enlargement of tumors or the appearance of new tumors followed by tumor shrinkage or long-term stability of tumor size (4)."
So apparently the first or even few initial scans after the start of these drugs should not be considered as definitive to see if the drug is working as the response itself can create the appearance of the false progression on the initial scans.
Cancer Immunotherapy: Imaging Assessment of Novel Treatment Response Patterns and Immune-related Adverse Events
http://pubs.rsna.org/doi/full/10.1148/rg.352140121
It is avail. in fill text and all people on the novel/non-traditional chemotherapy drugs should read it.
They say (I copy from there):
"Early clinical experience with recombinant cytokines, cancer vaccines, and immunomodulatory monoclonal antibodies has demonstrated a delayed response to treatment compared with that of cytotoxic chemotherapy, clinically significant disease stability, and transient enlargement of tumors or the appearance of new tumors followed by tumor shrinkage or long-term stability of tumor size (4)."
So apparently the first or even few initial scans after the start of these drugs should not be considered as definitive to see if the drug is working as the response itself can create the appearance of the false progression on the initial scans.