In Reply We would like to thank Pearson and Sweis for their insightful comments on our article.1 To evaluate the occurrence of hyperprogression (HPD) in patients with non–small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICIs), we studied 3 CT scans, 2 scans performed before (CT scans A and B) and 1 scan performed after ICI therapy (CT scan C).1 The speed of growth is reflected by the tumor growth rate (TGR) evaluated before (A vs B) and during ICI therapy (B vs C). Our definition of HPD was very stringent: if the tumor growth was 10% per month before ICI therapy, it must exceed 60% after therapy and more than 80% per month if tumor growth was 30% before ICI therapy. We believe that such a change in tumor growth cannot be explained by the natural history of NSCLC, but reflects an intrinsic negative effect of ICI therapy. To support that belief, we performed the same measurements among patients receiving single-agent chemotherapy.
Ferrara R, Caramella C, Besse B. Hyperprogression—Immunotherapy-Related Phenomenon vs Intrinsic Natural History of Cancer—In Reply. JAMA Oncol. Published online March 21, 20195(5):744. doi:10.1001/jamaoncol.2019.0138
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