Case Report

Imaging findings can’t mean everything in the era of immunotherapy: a case report and literature review

Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China

‡Xiangye Zhao and Kewei Ma are co-first authors

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Kewei Ma‡

https://orcid.org/0000-0003-2987-576X

Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China

‡Xiangye Zhao and Kewei Ma are co-first authors

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Xiaobo Ma

Department of pathology, The First Hospital of Jilin University, Changchun, Jilin, 130021, China

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Xu Wang

Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China

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Chao Sun

Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China

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Shi Qiu

Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China

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Ye Guo

Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China

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Zhiguang Yang

Thoracic Surgery Department, The First Hospital of Jilin University, Changchun, Jilin, 130021, China

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Yunpeng Liu

Thoracic Surgery Department, The First Hospital of Jilin University, Changchun, Jilin, 130021, China

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Yinghui Xu

*Author for correspondence:

E-mail Address: xuyinghui@jlu.edu.cn

https://orcid.org/0000-0003-0061-7345

Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, 130021, China

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Published Online:19 Dec 2023https://doi.org/10.2217/imt-2023-0158

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Abstract

Immune-checkpoint inhibitors (ICIs) play an important role in the treatment of cancers. However, immunotherapy can also induce atypical response patterns, including pseudoprogression, which is challenging to clinicians. We reported a case of non-small-cell lung cancer showing so-called pseudoprogression during the treatment of pembrolizumab and the patient benefited clinically from continued treatment with ICIs. Therefore, beside imaging evaluation, the assessment of Eastern Cooperative Oncology Group performance status score, numerical rating scale score of cancer pain, tumor markers levels, and neutrophil-to-lymphocyte ratio should be used for response evaluation of tumors in the era of immunotherapy. And more accurate evaluation methods and reliable information are urgently needed to better understand the pseudoprogression.

Plain language summary

Sometimes drugs can kill cancer cells but rather than getting smaller, as expected, the tumor size increases. This is called ‘pseuoprogression’, meaning false progression. Here, we report pseudoprogression in a lung cancer patient receiving immunotherapy. The tumor initially got larger, but with continued treatment, it decreased in size.

Tweetable abstract

This article reports a case of non-small-cell lung cancer that showed so-called pseudoprogression during immunotherapy combined with chemotherapy. The article also reviewed the mechanisms, clinical manifestations and prognostic indicators of pseudoprogression.

Keywords:

Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 16, No. 2

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History

Received 22 July 2023

Accepted 17 November 2023

Published online 19 December 2023

Published in print February 2024

Information

Keywords

Author contributions

XY Zhao and KW Ma reviewed the literature, designed and wrote the manuscript. XB Ma contributed to the pathologic diagnosis. X Wu, C Sun, Q Shi, Y Guo, ZG Yang and YP Liu reviewed the case and aided in acquisition the data. YH Xu conceived the manuscript and contributed to the critical revision of the manuscript for important intellectual content and approve the final version of the manuscript. All authors approved the final manuscript.

Acknowledgments

The authors acknowledge the valuable contributions of specialists from the Surgery, Internal Medicine, Pathology, Radiotherapy, and Imaging Departments.

Financial disclosure

This study was supported by the Natural Science Foundation of Jilin Province (20200201372JC). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, stock ownership or options and expert testimony.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

This study was approved by the Ethics Committee of the First Hospital of Jilin University (approval number: 2022-296). The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Consent for publication

Written informed consent was obtained from her family for publication of this case report and any accompanying images.

Availability of data and materials

The dataset supporting the findings and conclusions of this case report is included within the article and figures. Informed consent was obtained for publication of data by her family. The authors consulted the ethics committee of the First Hospital of Jilin University when collecting the data and obtained the ethical approval.

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