Indications of immunotherapy in oncology are continuously expanding, and unconventional types of response have been observed with these new treatments. These include transient progressive disease followed by a partial response, described as pseudoprogression, that raises the question of treatment beyond progression; and rapid disease progression associated with clinical decline, reported as hyperprogression. However, there are currently no consensual definitions of these phenomena and their impact on daily practice remains unclear. We reviewed existing data on pseudoprogression and hyperprogression with a focus on the definitions, incidence, predictive factors, potential biological mechanisms, and methods published to help distinguish pseudoprogression from progression and hyperprogression. The incidence of pseudoprogression ranged from 0 to 15%, with some authors also including disease stabilization after a first progression. For hyperprogression, incidence ranged from 4 to 29% with various definitions, and several authors reported a correlation with worse survival. Both phenomena were observed in a large panel of cancer types. Several radiological and biological methods have been reported to help distinguish pseudoprogression from progression and hyperprogression, such as analysis of radiomics, and circulating-tumor DNA or cell-free DNA, but these need to be confirmed in larger prospective cohorts. In conclusion, pseudoprogression and hyperprogression are both frequent types of responses under immunotherapy, and there is a need to better characterize these to improve the management of cancer patients. Treatment beyond progression should always be considered with caution and necessitates close clinical monitoring. In case of suspected hyperprogression, immunotherapy should be stopped early.

中文翻译：

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伪进展和过度进展是对免疫治疗的新形式。

肿瘤学中免疫疗法的指征正在不断扩大，这些新疗法已观察到非常规的反应类型。这些包括暂时性进行性疾病，然后是部分反应，称为伪进展，这引起了超越进展的治疗问题。与疾病恶化相关的快速疾病进展，据报道为过度进展。但是，目前尚无这些现象的共识定义，它们对日常操作的影响仍不清楚。我们回顾了有关假进行和过度发展的现有数据，重点关注定义，发生率，预测因素，潜在的生物学机制和已发布的有助于区分假进行与进展和过度进行的方法的数据。伪进展的发生率在0％到15％之间，有些作者还包括疾病的稳定过程。对于过度进展，各种定义的发生率在4％到29％之间，并且有几位作者报告了其与较差的生存率相关。在一大批癌症类型中都观察到了这两种现象。据报道，有几种放射学和生物学方法可帮助区分伪进展与进展和过度进展，例如放射组学分析，循环肿瘤DNA或无细胞DNA分析，但这些需要在更大的前瞻性队列中得到证实。总之，假性进展和过度进展都是免疫疗法中常见的反应类型，因此需要更好地表征这些特征以改善癌症患者的治疗。超过进展的治疗应始终谨慎考虑，并需要密切的临床监测。如果怀疑过度进展，应尽早停止免疫治疗。