Passler M, Taube ET, Sehouli J, Pietzner K. Pseudo- or real progression? An ovarian cancer patient under nivolumab: A case report. World J Clin Oncol 2019; 10(7): 247-255 [PMID: 31396474 DOI: 10.5306/wjco.v10.i7.247]
Corresponding Author of This Article
Mona Passler, Junior Researcher, Department of Gynecology, Competence Center for Ovarian Cancer (EKZE), Charité - University Medicine, Augustenburger Platz 1, Berlin 13353, Germany. mona.passler@charite.de
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Jul 24, 2019; 10(7): 247-255 Published online Jul 24, 2019. doi: 10.5306/wjco.v10.i7.247
Pseudo- or real progression? An ovarian cancer patient under nivolumab: A case report
Mona Passler, Eliane T Taube, Jalid Sehouli, Klaus Pietzner
Mona Passler, Jalid Sehouli, Klaus Pietzner, Department of Gynecology, Competence Center for Ovarian Cancer (EKZE), Charité - University Medicine, Berlin 13353, Germany
Eliane T Taube, Institute of Pathology, Charité University Hospital, Berlin 10117, Germany
Author contributions: Passler M reviewed the literature, contributed to manuscript drafting and was responsible for the submission process; Eliane T Taube was responsible for the pathological findings and review of the literature; Sehouli J and Pietzner K were the attending doctors and responsible for important intellectual content.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mona Passler, Junior Researcher, Department of Gynecology, Competence Center for Ovarian Cancer (EKZE), Charité - University Medicine, Augustenburger Platz 1, Berlin 13353, Germany. mona.passler@charite.de
Telephone: +49-157-59552338
Received: February 28, 2019 Peer-review started: March 4, 2019 First decision: April 11, 2019 Revised: July 8, 2019 Accepted: July 16, 2019 Article in press: July 17, 2019 Published online: July 24, 2019 Processing time: 146 Days and 11.3 Hours
Abstract
BACKGROUND
Checkpoint-Inhibition has revolutionized the treatment for several entities such as melanoma and renal cell carcinoma. The first encouraging experience in ovarian cancer was reported for nivolumab, a fully humanized anti-programmed death-1 antibody. Pseudoprogression is a new phenomenon associated with these novel immuno-oncologic agents. It can be explained by infiltrating leucocytes and edema that result in a temporary increase in tumor size and delayed subsequent shrinkage due to tumor cell destruction.
CASE SUMMARY
We report on a 47-year old patient with platinum-resistant ovarian cancer that was treated off-label with nivolumab 3mg/kg iv d1q14d. She first experienced classic pseudoprogression with inguinal lymph node swelling after cycle two and subsequent shrinkage. After 6 cycles she presented with rectal bleeding and progressive disease was diagnosed due to new tumor infiltration into the rectum.
CONCLUSION
Clinicians should be aware of pseudoprogression, its underlying mechanisms and strategies to discriminate pseudo- from real progression in ovarian cancer.
Core tip: Clinicians have to be aware of the phenomenon of pseudoprogression despite its rather rare occurrence. As both- pseudo-progression and real progression present with an increase in tumor size, the only certain way to differentiate between them is the occurrence of infiltrating growth. While the increase of tumor size in pseudoprogression can be explained by benign growth due to immune cell infiltration and edema, only malign growth of a real progression has the ability to infiltrate other tissues. When in doubt whether a pseudoprogression has occurred, we suggest cautious continuation of checkpoint-inhibition paired with corticoids to lower adverse effects if necessary.
