Managing Hyperprogressive Disease in the Era of Programmed Cell Death Protein 1/Programmed Death‐Ligand 1 Blockade: A Case Discussion and Review of the Literature

摘要

A breakthrough in oncology over the last 5 years, immunotherapy has proved its salutary effects in a wide range of solid tumors. The targeting of the programmed cell death protein 1 (PD‐1)/programmed death‐ligand 1 (PD‐L1) pathway can restore a competent antitumor T‐cell response by addressing key tumor immune evasion mechanisms. This novel mechanism of action is associated with new patterns of responses that were not observed with conventional treatments such as chemotherapy or targeted therapies. Thus, hyperprogressive disease (HPD), an unexpected acceleration of cancer evolution after starting immunotherapy, has been reported by several groups with a PD‐1/PD‐L1 blockade. This tumor flare‐up phenomenon is associated with a poorer outcome and is suspected to be an immune‐related adverse event. Despite been highly debated, the issue of HPD is currently a real challenge for oncologists’ practice in terms of patients’ information, diagnosis, and management. Herein, we describe the case of a 57‐year‐old man diagnosed with metastatic urothelial carcinoma who developed a rapid tumor growth after an anti‐PD‐L1+ IO combination. This case illustrates how current practice should evolve to address the HPD reality in the anticheckpoint era.