Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases

Surabhi Ranjan; Martha Quezado; Nancy Garren; Lisa Boris; Christine Siegel; Osorio Lopes Abath Neto; Brett J. Theeler; Deric M. Park; Edjah Nduom; Kareem A. Zaghloul; Mark R. Gilbert; Jing Wu

doi:10.1186/s12885-018-4131-1

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Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases

Journal article

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Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases

Surabhi Ranjan, Martha Quezado, Nancy Garren, Lisa Boris, Christine Siegel, Osorio Lopes Abath Neto, Brett J. Theeler, Deric M. Park, Edjah Nduom, Kareem A. Zaghloul, …

BMC cancer, Vol.18(1), pp.239-239

03/01/2018

DOI: 10.1186/s12885-018-4131-1

PMCID: PMC5831705

PMID: 29490632

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Abstract

Background: Immune checkpoint inhibitors (ICPIs) are being investigated in clinical trials for patients with glioblastoma. While these therapies hold great promise, management of the patients receiving such treatment can be complicated due to thechallenges in recognizing immune-related adverse events caused by checkpoint inhibitor treatment. Brain imaging changes that are the consequence of an inflammatory response may be misinterpreted as disease progression leading to inappropriate premature cessation of treatment. The aim of this study was to, by way of a series of cases, underscore the challenges in determining the nature of contrast-enhancing masses that develop during the treatment of patients with glioblastoma treated with ICPIs. Case presentation: We reviewed the clinical course and management of 4 patients on ICPIs who developed signs of tumor progression on imaging. These findings were examined in the context of Immunotherapy Response Assessment in Neuro-Oncology (iRANO) guidelines. Although all 4 patients had very similar imaging findings, 2 of the 4 patients were later found to have intense inflammatory changes (pseudoprogression) by pathologic examination. Conclusions: A high index of suspicion for pseudoprogression needs to be maintained when a patient with brain tumor on immunotherapy presents with worsening in an area of a pre-existing tumor or a new lesion in brain. Our findings strongly suggest that pathological diagnosis remains the gold standard for distinguishing tumor progression from pseudoprogression in patients receiving immunotherapy. There is a large unmet need to develop reliable non-invasive imaging diagnostic techniques.

Immunotherapy

Case Report

CTLA-4

Immune checkpoint inhibitors

Ipilimumab

iRANO

Nivolumab

PD-1

Pseudoprogression

Details

Title: Subtitle: Clinical decision making in the era of immunotherapy for high grade-glioma: report of four cases
Creators: Surabhi Ranjan - National Cancer Institute
Martha Quezado - National Institutes of Health
Nancy Garren - National Cancer Institute
Lisa Boris - Leidos Biomedical Research Inc. (United States)
Christine Siegel - Leidos Biomedical Research Inc. (United States)
Osorio Lopes Abath Neto - Bethesda, MD 20892 USA
Brett J. Theeler - Walter Reed National Military Medical Center
Deric M. Park - National Cancer Institute
Edjah Nduom - National Institute of Neurological Disorders and Stroke
Kareem A. Zaghloul - National Institute of Neurological Disorders and Stroke
Mark R. Gilbert - National Cancer Institute
Jing Wu - National Cancer Institute
Resource Type: Journal article
Publication Details: BMC cancer, Vol.18(1), pp.239-239
DOI: 10.1186/s12885-018-4131-1
PMID: 29490632
PMCID: PMC5831705
NLM abbreviation: BMC Cancer
ISSN: 1471-2407
eISSN: 1471-2407
Publisher: BioMed Central
Grant note: Intramural funding / ;
Language: English
Date published: 03/01/2018
Academic Unit: Pathology
Record Identifier: 9984276457002771

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