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Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University

Chief of Hematology/Oncology
Medical Director of Memorial Cancer Institute

Lung Cancer Video Library - Spanish Language: Video #30 Time to Response on Immune Checkpoint Inhibitors and the Concept of Pseudoprogression
Mon, 02/13/2017 - 17:10
Luis Raez, MD FACP FCCP, Faculty, Board Member

Tiempo de respuesta en los inhibidores de puntos de control inmunológicos y el concepto de pseudoprogresión

 Response time in immunological checkpoint inhibitors and the concept of pseudo progression


 Dr. Luis Raez, MD FACP FCCP

Chief of Hematology/Oncology and Medical Director, Memorial Cancer Institute,
Clinical Associate Professor of Medicine, Florida International University



Otra pregunta muy común de los pacientes y médicos es el tiempo que se le tiene que dar inmunoterapia a los pacientes y la famosa pseudoprogresión. No sé si ustedes saben, pero normalmente cuando hacemos estudios clínicos con quimioterapia cada dos ciclos de quimioterapia checamos tomografías para ver la respuesta. Somos bien estrictos, más cuando es un estudio clínico porque dos ciclos de quimioterapia deben de ser suficiente para ver una respuesta en el tumor si no cambiamos de tratamiento. Pero dos ciclos de quimioterapia son seis semanas, entonces el paciente ha estado en este régimen seis semanas, solo para darle dos ciclos de quimioterapia.

Inmunoterapia actúa más lentamente, nosotros no podemos darle a alguien inmunoterapia por seis semanas y de ahí hacer una tomografía y decidir si respondió o no, porque hay pacientes que responden después (hasta cuatros meses después). Felizmente los pacientes que responden tarde no son suficientes, son alrededor del 10%, pero el resto va a responder en los dos meses que consideramos estándar.

Para propósitos prácticos y para tratar de no perder a estos pacientes que se pueden beneficiar tardíamente, muchos de nosotros cuando damos inmunoterapia nunca hacemos tomografías a las seis semanas, ni ocho semanas. Las hacemos a los tres meses para estar seguros que estamos registrando todo lo que está respondiendo. Después de tres meses si alguien no ha respondido, lo cambiamos a quimioterapia o a un estudio clínico.

Entonces probablemente no hay un consenso, pero preferimos hacer las tomografías cada tres meses para poder tomar todos los pacientes y registrar a todos los pacientes que se están beneficiando.

La única excepción sería es si hay pacientes que tienen enfermedad que pone en peligro su vida como efusión pericárdica o compresión de la vena cava, de repente el médico y el paciente no quieren esperar tres meses para decidir si la inmunoterapia funcionó o no. Ahí hay que ser abierto y en esos casos no se puede esperar tres meses para hacer la tomografía.



Another common question among patients and physicians is the time you have to give immunotherapy and the pseudo progression. When we make clinical trials with chemotherapy every two cycles, we make a tomography to see the response. We are very strict, more when it’s a clinical trial because two cycles of chemotherapy have to be more than enough to see a response in the tumor. If we don’t see it, we have to change the treatment. But two cycles of chemotherapy are six weeks, so the patient has been in this regimen for six weeks, only to receive two cycles of chemotherapy.

Immunotherapy acts more slowly, so we cannot give a patient immunotherapy for six weeks and then make a tomography and decide if it responded or not, because there are patients that respond later (even four months later). Luckily these patients that respond later are not many, around 10%. The rest will respond between the two months we consider standard.

For clinical purposes and to try to keep these late-responding patients, most of us don’t do a tomography in the next six or eight weeks after the immunotherapy. We do it about three months later to be sure the response is present. After three months if a patient has not responded, then we change him to chemotherapy or to a clinical trial.

There isn’t a consensus, but we prefer to make the tomograms every three months to be able to consider all the patients and register the ones that are beneficiating from it.

The only exception would be for patients who have a life threatening disease like pericardial effusion or compression of the vena cava. In those cases, the physician and the patient do not want to wait three months to decide if immunotherapy worked or not. In those cases, we have to be open and we cannot wait three months for the tomography.

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