Hyperprogressive disease (HPD) is a new phenomenon developing in the era of immune checkpoint inhibitor (ICI) therapy. HPD is characterized by an unexpected and fast progression in tumor volume and poor survival.There is no standardized definition for HPD and clinicopathological variables associated with HPD are unclear. Herein, we assessed incidence and factors predictive of HPD in patients terated with ICIs.
We retrospectively analysed patients with advanced cancer treated with ICI at Cerrahpasa Medical Faculty Clinical Trial Unit between 2014-2021. We used the Lo Russo’s adopted criteria combined clinical and radiologic parameters for the definition of HPD. All patients who underwent their first tumor evaluation according to RECIST1.1 were included.
Of 155 patients,147 were eligible for analysis. The median age was 61 and 83% were male. The cancer types were; 67,3% lung, 12,9% bladder, 9,5% gastric, 5,4% colon and 4,8% renal cell carcinoma. 59,9% patients were treatment naive and others had one or more lines of chemotherapy. There were 124 patients (84%) who received a single-agent ICI as PD-1 or PD-L1 inhibitors. 23 (16%) patients were treated with combination ICI with anti VEGF, TKI or other ICIs. The median duration of follow-up was 15,6 months. Incidence of HPD was 12,9%. Patients with progressive disease (PD) without HPD were the 20,4%. The median overall survival (mOS) was 3,0 months for HPD patients and 23,1 months for non-HPD patients (p <.001). The mOS for HPD and PD without HPD was 3,0 vs 7,7 months respectively (p <.001). In the univariate analysis (HPD vs non-HPD group) baseline sum of diameters of the lesions (p=0.040) and the baseline high LDH levels (p=0.040) were associated with HPD.
With increased use of ICIs, early recognition of HPD that is predicting very poor survival, will provide insight for the physicians in the management of cancer patients.
G. Alkan.
Has not received any funding.
All authors have declared no conflicts of interest.