What is “Hyperprogression” in metastatic lung cancer?

Recently, on September 6, 2018, it was published in one of the world’s most prestigious medical journals, the JAMA, a very worrisome article presenting the results of a study conducted at eight leading medical centers in France, including the leading cancer center in Europe, Gustave Roussy.

What is “Hyperprogression”?

Hyperprogression is the accelerated progression of cancerous tumors following treatment the patient receives.

The study examined Hyperprogression in patients with advanced lung cancer and metastatic lung cancer patients, stage 4, who were treated with immunotherapy.

Although immunotherapy has revolutionized the treatment of lung cancer and other cancers, doctors have noticed that immunotherapy is harmful to some patients to the extent that there are more deaths with immunotherapy than chemotherapy!

Doctors believe that immunotherapy can cause accelerated growth of cancer, and this is based on earlier publications.

The study compared 406 metastatic lung cancer and stage 3 and 4 patients, who were treated with immunotherapy to 59 stage 3 and 4 lung cancer patients who received chemotherapy for their disease.

Results showed that 14% of patients treated with immunotherapy experienced Hyperprogression compared with 5% of patients receiving chemotherapy.

Hyperprogression occurred mainly in stage 4 metastatic lung cancer patients with over 2 metastases.

The researchers of this work claim that if they included in their calculations patients who developed new metastases under treatment, patients who had unmeasurable metastases, for example, bone metastasis and very deteriorated patients, the percentages in both immunotherapy and chemotherapy were even higher!

All patients received second treatment for their advanced disease, “second line”. For a lung cancer patient who developed Hyperprogression, life expectancy was only 3.8 months, compared to 6.2 months in a lung cancer patient who did not develop Hyperprogression.

The problem is that there is currently no marker to predict which patients may develop Hyperprogression under immunotherapy and who may not. Therefore, after starting immunotherapy, it is recommended to do CT faster than normally done and if there is Hyperprogression, replace treatment immediately.

In addition, combination of chemotherapy plus immunotherapy in patients with stage 4 lung cancer, seem to prevent the development of Hyperprogressions in the high percentages observed in the study.

On the other hand, if that’s the case, we did not get rid of chemotherapy and that is one of the goals of immunotherapy, as long as it proves to be better.

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