Pseudoprogression in microsatellite instability-high colorectal cancer during treatment with combination T cell mediated immunotherapy: A case report and literature review

Young Kwang Chae*, Si Wang, Halla Nimeiri, Aparna Kalyan, Francis J. Giles

*Corresponding author for this work

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Evading tumor-mediated immunosuppression through antibodies to immune checkpoints has shown clinical benefit in patients with select solid tumors. There is a heterogeneity of responses in patients receiving immunotherapy, including pseudoprogression in which the tumor burden increases initially before decreasing to reach disease control. The characteristics and basis of pseudoprogression, however, remains poorly understood. We hereby report a case of microsatellite instability (MSI)-high metastatic colorectal cancer treated with combination of OX40 agonist and programmed death ligand-1 (PD-L1) antagonist that demonstrated pseudoprogression reaching 163% increase from baseline tumor burden. Tumor regression was subsequently observed and patient has remained in stable disease. Despite the substantial radiological progression, the symptomatic improvement reported by the patient led us to the decision of treatment continuation based on the suspicion of pseudoprogression, illustrating the importance of clinical evaluation in medical decision making while managing patients on immunotherapy. Additionally, the patient's MSI-high status contributes to his good, maintained response to PDL1 blockade. Our case provides a frame of reference for fluctuation in tumor burden associated with pseudoprogression. Here we also evaluate the incidence and scale of pseudoprogression across solid tumor types.

Original languageEnglish (US)
Pages (from-to)57889-57897
Number of pages9
JournalOncotarget
Volume8
Issue number34
DOIs
StatePublished - 2017

Keywords

  • Anti-programmed death ligand-1 antibody
  • Immune checkpoint inhibitors
  • Immune-related response
  • Metastatic colorectal cancer
  • Pseudoprogression

ASJC Scopus subject areas

  • Oncology

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