Acta oncologica (Stockholm, Sweden) · 2026
Incidence and impact of pseudoprogression and mixed responses in metastatic renal cell carcinoma patients treated with ipilimumab/nivolumab: a retrospective analysis.
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Caeyman Aaron, Mammone Giulia, Kinget Lisa, Baldewijns Marcella, De Wever Liesbeth, Albersen Maarten, Debruyne Philip R, Demeulenaere Octavie, McTaggart Edward Scott, Saraswat Saurabh, Berghen Charlien, De Meerleer Gert, Naulaerts Stefan, Garg Abhishek D, Beuselinck Benoit
Аннотация
INTRODUCTION: Immune checkpoint inhibitors can elicit atypical responses such as pseudoprogression (psPD) and mixed responses (MR). We aimed to analyze the occurrence and prognostic impact of atypical responses in metastatic clear-cell renal cell carcinoma (m-ccRCC) patients treated with ipilimumab/nivolumab.
MATERIALS AND METHODS: In this retrospective series of m-ccRCC patients treated with ipilimumab/nivolumab in first-line, we performed radiographic evaluation using Response Evaluation Criteria in Solid Tumors and iRECIST consensus guidelines and compared both methods.
RESULTS: We assessed 258 baseline target lesions in 100 eligible patients. MR occurred in 24% of patients. In 15 patients (62%), the MR evolved to confirmed progressive disease (cPD), while in nine patients (38%), the MR evolved toward a partial response (PR) and was thus a psPD. psPD occurred in 13% of patients: with increase of all lesions in four patients or with MR features in nine patients. psPD patients had the second best time-to-progression (TTP) and cancer-specific survival (CSS), slightly lower compared to TTP and CSS in patients with PR without a phase of psPD and better than TTP and CSS in patients with stable disease as best response. From all patients who presented with PD at first CT evaluation (n = 40), including 17 patients with unconfirmed progressive disease and 23 patients with MR, in 12 (30%) patients this was a psPD and led to a PR.
CONCLUSIONS: Atypical responses such as psPD and MR occurred in 13 and 24% of m-ccRCC patients treated with ipilimumab/nivolumab. Patients with psPD had favorable outcomes, while MR in most cases evolved to progression.
MATERIALS AND METHODS: In this retrospective series of m-ccRCC patients treated with ipilimumab/nivolumab in first-line, we performed radiographic evaluation using Response Evaluation Criteria in Solid Tumors and iRECIST consensus guidelines and compared both methods.
RESULTS: We assessed 258 baseline target lesions in 100 eligible patients. MR occurred in 24% of patients. In 15 patients (62%), the MR evolved to confirmed progressive disease (cPD), while in nine patients (38%), the MR evolved toward a partial response (PR) and was thus a psPD. psPD occurred in 13% of patients: with increase of all lesions in four patients or with MR features in nine patients. psPD patients had the second best time-to-progression (TTP) and cancer-specific survival (CSS), slightly lower compared to TTP and CSS in patients with PR without a phase of psPD and better than TTP and CSS in patients with stable disease as best response. From all patients who presented with PD at first CT evaluation (n = 40), including 17 patients with unconfirmed progressive disease and 23 patients with MR, in 12 (30%) patients this was a psPD and led to a PR.
CONCLUSIONS: Atypical responses such as psPD and MR occurred in 13 and 24% of m-ccRCC patients treated with ipilimumab/nivolumab. Patients with psPD had favorable outcomes, while MR in most cases evolved to progression.