In Reply We thank Matos and Garralda for their interest and insightful comments on our article.1 We agree that hyperprogressive disease (HPD), although believed to be associated with immunotherapy, is a pattern of tumoral behavior that in theory could be encountered with other systemic treatments. The objective of our study did not intend to solve this controversy but to provide the more accurate definition of hyperprogression so that future researches on that topic could be reproducible. We selected studies on hyperprogression in the literature that included a prebaseline assessment to estimate the pretreatment tumor growth rate (TGR); most of them had no control group to test our definition with other systemic treatment.
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Caramella C, Ferrara R, Besse B. Clarification of Definitions of Hyperprogressive Disease During Immunotherapy—Reply. JAMA Oncol. 2021;7(1):137. doi:10.1001/jamaoncol.2020.5591
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