A hypothesis of progression of malignancy based on immune responses Dotaz Zobrazit nápovědu
In recent years, the number of approved and investigational agents that can be safely administered for the treatment of lymphoma patients for a prolonged period of time has substantially increased. Many of these novel agents are evaluated in early-phase clinical trials in patients with a wide range of malignancies, including solid tumors and lymphoma. Furthermore, with the advances in genome sequencing, new "basket" clinical trial designs have emerged that select patients based on the presence of specific genetic alterations across different types of solid tumors and lymphoma. The standard response criteria currently in use for lymphoma are the Lugano Criteria which are based on [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography or bidimensional tumor measurements on computerized tomography scans. These differ from the RECIST criteria used in solid tumors, which use unidimensional measurements. The RECIL group hypothesized that single-dimension measurement could be used to assess response to therapy in lymphoma patients, producing results similar to the standard criteria. We tested this hypothesis by analyzing 47 828 imaging measurements from 2983 individual adult and pediatric lymphoma patients enrolled on 10 multicenter clinical trials and developed new lymphoma response criteria (RECIL 2017). We demonstrate that assessment of tumor burden in lymphoma clinical trials can use the sum of longest diameters of a maximum of three target lesions. Furthermore, we introduced a new provisional category of a minor response. We also clarified response assessment in patients receiving novel immune therapy and targeted agents that generate unique imaging situations.
- Klíčová slova
- FDG-PET, immunotherapy, lymphoma, response criteria, targeted therapy, waterfall plots,
- MeSH
- antitumorózní látky škodlivé účinky terapeutické užití MeSH
- časové faktory MeSH
- fluorodeoxyglukosa F18 aplikace a dávkování MeSH
- konsensus MeSH
- kontrastní látky aplikace a dávkování MeSH
- kritéria léčebné odpovědi * MeSH
- lidé MeSH
- nehodgkinský lymfom diagnostické zobrazování farmakoterapie mortalita patologie MeSH
- počítačová rentgenová tomografie normy MeSH
- pozitronová emisní tomografie normy MeSH
- prediktivní hodnota testů MeSH
- přežití po terapii bez příznaků nemoci MeSH
- progrese nemoci MeSH
- staging nádorů MeSH
- stanovení cílového parametru MeSH
- tumor burden MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- konsensus - konference MeSH
- přehledy MeSH
- směrnice pro lékařskou praxi MeSH
- Názvy látek
- antitumorózní látky MeSH
- fluorodeoxyglukosa F18 MeSH
- kontrastní látky MeSH
PURPOSE: To investigate the association of patients' sex with recurrence and disease progression in patients treated with intravesical bacillus Calmette-Guérin (BCG) for T1G3/HG urinary bladder cancer (UBC). MATERIALS AND METHODS: We analyzed the data of 2635 patients treated with adjuvant intravesical BCG for T1 UBC between 1984 and 2019. We accounted for missing data using multiple imputations and adjusted for covariate imbalance between males and females using inverse probability weighting (IPW). Crude and IPW-adjusted Cox regression analyses were used to estimate the hazard ratios (HR) with their 95% confidence intervals (CI) for the association of patients' sex with HG-recurrence and disease progression. RESULTS: A total of 2170 (82%) males and 465 (18%) females were available for analysis. Overall, 1090 (50%) males and 244 (52%) females experienced recurrence, and 391 (18%) males and 104 (22%) females experienced disease progression. On IPW-adjusted Cox regression analyses, female sex was associated with disease progression (HR 1.25, 95%CI 1.01-1.56, p = 0.04) but not with recurrence (HR 1.06, 95%CI 0.92-1.22, p = 0.41). A total of 1056 patients were treated with adequate BCG. In these patients, on IPW-adjusted Cox regression analyses, patients' sex was not associated with recurrence (HR 0.99, 95%CI 0.80-1.24, p = 0.96), HG-recurrence (HR 1.00, 95%CI 0.78-1.29, p = 0.99) or disease progression (HR 1.12, 95%CI 0.78-1.60, p = 0.55). CONCLUSION: Our analysis generates the hypothesis of a differential response to BCG between males and females if not adequately treated. Further studies should focus on sex-based differences in innate and adaptive immune system and their association with BCG response.
- Klíčová slova
- Age, BCG, Bladder cancer, Progression, Recurrence, Response,
- MeSH
- adjuvancia imunologická aplikace a dávkování MeSH
- aplikace intravezikální MeSH
- BCG vakcína aplikace a dávkování MeSH
- imunoterapie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory močového měchýře farmakoterapie patologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- sexuální faktory MeSH
- stupeň nádoru MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Názvy látek
- adjuvancia imunologická MeSH
- BCG vakcína MeSH