AACR 2021: Rare Case of Thyroid Cancer Hyperprogression After Immunotherapy
Posted: Friday, April 30, 2021
At the American Association for Cancer Research (AACR) Annual Meeting 2021, Young Kwang Chae, MD, of Northwestern University Feinberg School of Medicine, Chicago, and colleagues presented reportedly the first case of follicular thyroid cancer that developed hyperprogression after combination immunotherapy (Abstract 519). This patient had no PD-L1 expression and did not display any targetable mutations.
A 53-year-old man presented with stage IV follicular thyroid cancer and multiple skeletal metastasis in his ribs and vertebrae. The patient was treated with lenvatinib but returned 11 months later due to esophagus dilation. Nivolumab and ipilimumab were administered, yet the patient could not continue therapy because of neurologic disease progression discovered on a follow-up CT scan.
The patient experienced tingling and numbness in his upper extremities at baseline. Prior to immunotherapy initiation, there were no target lesions observed by a CT chest scan. During follow-up imaging 3 weeks after the start of immunotherapy, a 24.4 x 18.4 mm right hilar lymph node metastasis was revealed by CT chest scan, and a 6.7 x 4.2 cm right shoulder heterogeneous mass was found by scapula MRI.
Hyperprogression was defined as meeting at least three of the following criteria: an increase larger than 50% in the sum of target lesions major diameters, tumor-treating fields for up to 2 months, an Eastern Cooperative Oncology Group (ECOG) performance status worse than 2 in the first 2 months, at least two new lesions in an already-affected organ, and the spread of disease to a new organ. Since the patient had a target lesion diameter sum of 85.4 mm, was treated for up to 2 months, and had an ECOG performance status of 2, he met the criteria for hyperprogression.
Disclosure: The study authors reported no conflicts of interest.