Immunotherapy trials and hyperprogressive disease

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Published: 2 Jun 2018
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Dr Elena Garralda - Vall d´Hebron Institute of Oncology (VHIO), Barcelona, Spain

Dr Garralda speaks with ecancer at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting about ongoing immunotherapy trials being conducted in Vall d´Hebron.

She goes on to discuss a new definition of hyperprogression , suggested to bypass the need for a CT scan before treatment.

Currently in the unit we are working with many immunotherapy clinical trials; around half of our portfolio is in fact in immunotherapy clinical trials and we are investing a lot of efforts, trying to see which patients will actually benefit on treatment and which ones won’t. As well, as you know, there is this phenomenon that has been called hyperprogressive disease which are, in fact, patients that could perhaps have had a deleterious effect of immunotherapy. The first definition was by Gustave Roussy but it’s a challenging definition to implement in the clinic as we require the previous CT scan to see the rate of growth previous to the beginning of treatment.

So in the unit we have been working to try to find a new definition. This work has been led by Dr Matos as one of the clinical investigators in my group and he will be presenting this in the poster session on Monday. So what we actually found is studying the 200 patients that had been treated with immunotherapy in the unit, we saw that those patients that had progression as best response, those patients that had in fact had a 40% increase of target lesions or that had 20% increase but had the appearance of multiple new mets in different organs which we called hyperprogression disease, and this is our new definition, had actually a worse survival that was statistically significant when compared to those patients that had progressive disease in their first scanning but that did not meet this criteria. This was, as I have said, statistically significant with an important difference in survival.

So, one of our readings is that, in fact, these patients should not continue to be treated upon progression because we see that their survival is very bad. So, as you know, right now in immunotherapy clinical trials most of the protocols allow to continue treatment beyond progression, as we have seen some patients that have pseudo-progressive disease while we believe that these patients should not be continued to be treated. We are trying to validate our definition and compare our definition with Gustave Roussy and this is work that will be, in fact, presented in ESMO. We are working to try to define these patients beforehand but we think it’s important to be able to define these patients quickly in order to change treatment and not continue with the same strategy.