Clinical characteristics of hyperprogressive disease in NSCLC after treatment with immune checkpoint inhibitor: a systematic review and meta-analysis

Yan Chen,Haiping Zhang,Junjie Hu,Peng Zhang,Fangfang Bu,Ke Fei

doi:10.1186/s12885-020-07206-4

Yan Chen, Haiping Zhang + Show 4 more

Open Access

https://doi.org/10.1186/s12885-020-07206-4

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Journal: BMC Cancer	Publication Date: Jul 29, 2020
Citations: 23	License type: open-access

Affiliation: Tongji University, Shanghai Pulmonary Hospital

Abstract

BackgroundA number of studies have reported hyperprogressive disease (HPD) in non-small cell lung cancer (NSCLC) after treatment with immune checkpoint inhibitor (ICI). This study aimed to summarize the incidence and survival outcome of HPD in NSCLC and identify the clinicopathological features associated with HPD based on available eligible studies.MethodsFour databases (Medline/PubMed, Embase, Web of Science, and Cochrane Library) were searched for eligible studies on HPD published before January 23, 2020, to evaluate the incidence, outcome, and clinical features of HPD. Statistical analyses were performed using STATA 15.0. All meta-analyses were performed based on the random-effects model.ResultsThis study included 6 studies involving 1389 patients. The incidence of HPD ranged from 8.02 to 30.43%. Compared with patients with non-HPD, those with HPD were associated with worse overall survival. We identified that Eastern Cooperative Oncology Group > 1, Royal Marsden Hospital score ≥ 2, serum lactate dehydrogenase > upper limit of normal, the number of metastasis sites > 2, and liver metastasis were associated with the risk of HPD.ConclusionsThis study summarized the clinical features of HPD in NSCLC patients. The meta-analysis showed that five pre-treatment clinicopathological features might be associated with HPD, which may help in selecting patients for ICIs.

Highlights

A number of studies have reported hyperprogressive disease (HPD) in non-small cell lung cancer (NSCLC) after treatment with immune checkpoint inhibitor (ICI)
A more profound understanding of HPD might help determine the position of ICIs in the management of NSCLC and identify patients who might progress after immunotherapy
23 studies were identified for further review in full text, of which 17 were eliminated because no sufficient data was reported about HPD and non-HPD group

Summary

Introduction

A number of studies have reported hyperprogressive disease (HPD) in non-small cell lung cancer (NSCLC) after treatment with immune checkpoint inhibitor (ICI). This study aimed to summarize the incidence and survival outcome of HPD in NSCLC and identify the clinicopathological features associated with HPD based on available eligible studies. Immune checkpoint inhibitor (ICIs) have shown sustained responses in different advanced-stage cancers, including non-small cell lung cancer (NSCLC) [1, 2]. HPD has been reported across different tumor types, Inhwan Hwang suggested that the incidence and risk factors of HPD might differ according to cancer type [9]. The clinical characteristics of HPD in NSCLC, such as the incidence, outcome and predictors of HPD are not well understood.

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