Pseudoprogression and hyperprogression in lung cancer: a comprehensive review of literature
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REVIEW – CLINICAL ONCOLOGY
Pseudoprogression and hyperprogression in lung cancer: a comprehensive review of literature Laiyan Zhou1 · Mai Zhang1 · Rui Li1 · Jianxin Xue1 · You Lu1 Received: 22 May 2020 / Accepted: 18 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Immune checkpoint inhibitors are associated with clinical benefit in lung cancer. However, response patterns to immunotherapy, including pseudoprogression and hyperprogression, are difficult to diagnose, and their mechanisms remain unclear. This review aimed to describe two response patterns observed in lung cancer, namely pseudoprogression and hyperprogression, including their epidemiology, diagnostic characteristics, and plausible mechanisms. Methods We performed a comprehensive literature search in the PubMed database, using keywords “pseudoprogression”, “hyperprogression”, and “lung cancer”, among others. The literature was examined for pseudoprogression and hyperprogression characteristics and plausible mechanisms. Results Pseudoprogression manifests in multiple forms; however, the immune system-related response criteria and biopsy data are helpful to make accurate diagnosis. Serological biomarkers, such as neutrophil-to-lymphocyte ratio (NLR) and circulating tumor DNA (ctDNA), might help distinguish pseudoprogression from true progression. The incidence of hyperprogression ranges within 5–19.2%, depending on definition. The unique response pattern of rapid progression is observed not only with immunotherapy, but also with other treatment regimens. Molecular mutations and amplifications may result in hyperprogression; however, the exact mechanism remains unclear. Conclusion Atypical response patterns, such as pseudoprogression and hyperprogression, are increasingly common in clinical practice. Immune-related response criteria can help diagnose pseudoprogression. Molecular mechanisms of hyperprogression remain unclear. Biomarkers for pseudoprogression and hyperprogression are required. Keywords Immunotherapy · Pseudoprogression · Hyperprogression · Lung cancer
Introduction Lung cancer is the leading cause of cancer-related mortality worldwide. Forecasts of the American Cancer Society predict 228,820 new lung cancer cases and 135,720 associated deaths in 2020 alone (Siegel et al. 2020). Non-small cell lung cancer (NSCLC) is expected to account for 85% of all cases (Molina et al. 2008). Immunotherapy has recently revolutionized lung cancer treatment despite a long-held belief that lung cancer is a non-immunogenic disease (Raez * Jianxin Xue [email protected] * You Lu [email protected] 1
Department of Thoracic Cancer, Cancer Center, West China Hospital, West China School of Clinical Medicine, Sichuan University, Chengdu 610041, China
et al. 2004). In fact, several studies have reported that immunotherapy can improve survival and quality of life among patients with lung cancer (Brahmeret al. 2015; Borghaei et al. 2015; Herbst et al. 2016). Introduction of cytotoxic T lymphocyte-associated antige
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