Hyperprogressive disease in patients with advanced renal cell carcinoma: a new pattern of post-treatment cancer behavior

Immunol Res. 2020 Aug;68(4):204-212. doi: 10.1007/s12026-020-09138-4.

Abstract

Renal cell carcinoma (RCC) is among the most common cancers of the genitourinary system. Once RCC has progressed to a high tumor stage, surgery is no longer the optimal option, and treatment with drugs is more suitable. However, a proportion of patients with advanced RCC (aRCC) experience accelerated progression following targeted therapy or immunotherapy, a condition known as hyperprogressive disease (HPD). There is a growing body of literature that recognizes the importance of HPD. In the present review, thousands of studies that describe a variety of treatments for aRCC were identified in PubMed, Web of Science, and Cochrane Library and analyzed to establish the severity of clinical outcomes. Therefore, we managed to perform a review related to HPD of aRCC in these databases. It was found that 7~74% of patients advanced into progressive disease, 0~45% of patients died during post-treatment assessment, possibly due to fatal HPD. However, risk factors, mechanisms, and predictive factors are still not entirely clear. It is suggested that combination therapies might play a pivotal role in preventing HPD. Additional light needs to be shed on customization of therapies for aRCC after more data is collected and analyzed for HPD.

Keywords: Hyperprogressive disease; Immune checkpoint inhibitors; Immunotherapy; Renal cell carcinoma; Targeted therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antineoplastic Agents, Immunological / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / pharmacology
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Carcinoma, Renal Cell / diagnosis*
  • Carcinoma, Renal Cell / drug therapy
  • Carcinoma, Renal Cell / mortality
  • Carcinoma, Renal Cell / pathology
  • Clinical Trials, Phase III as Topic
  • Disease Progression
  • Humans
  • Kidney Neoplasms / diagnosis*
  • Kidney Neoplasms / drug therapy
  • Kidney Neoplasms / mortality
  • Kidney Neoplasms / pathology
  • Molecular Targeted Therapy / methods
  • Neoplasm Staging
  • Progression-Free Survival
  • Risk Factors
  • Time Factors

Substances

  • Antineoplastic Agents, Immunological