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irano_criteria [2018/11/12 22:08]
administrador
irano_criteria [2018/11/12 22:12] (current)
administrador
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-====== Key differences between iRANO and RANO criteria ​======+===== Key differences between iRANO and RANO criteria =====
  
 new enhancing lesion outside the main radiation field are encountered in immunotherapy and therefore do not automatically denote progressive disease in iRANO new enhancing lesion outside the main radiation field are encountered in immunotherapy and therefore do not automatically denote progressive disease in iRANO
-the onset of therapeutic effect in immunotherapy can be delayed and thus iRANO requires a repeat scan (3 months later) to confirm disease progression on imaging criteria ​(see below)+the onset of therapeutic effect in immunotherapy can be delayed and thus iRANO requires a repeat scan (3 months later) to confirm disease progression on imaging criteria ​
  
-[[Immunotherapy]] is a promising area of [[therapy]] ​in patients with neuro-oncological malignancies. However, early-phase studies show unique challenges associated with the assessment ​of radiological changes ​in response ​to immunotherapy reflecting delayed responses or therapy-induced [[inflammation]]. Clinical benefit, including long-term survival ​and tumour regression, can still occur after initial disease ​progression or after the appearance ​of new lesions. Refinement of the response assessment criteria for patients with neuro-oncological malignancies undergoing immunotherapy ​is therefore warranted. Herein, ​a multinational and multidisciplinary panel of neuro-oncology immunotherapy experts ​describe immunotherapy Response Assessment for Neuro-Oncology (iRANO) criteria based on guidance for the determination of tumour progression outlined by the immune-related response criteria and the RANO working group. ​Among patients who demonstrate imaging findings meeting [[RANO]] criteria for progressive disease within 6 months of initiating immunotherapy,​ including the development of new lesions, confirmation of radiographic progression on follow-up imaging is recommended provided that the patient is not significantly worse clinically. The proposed criteria also include guidelines for the use of corticosteroids. ​We review ​the role of advanced imaging techniques and the role of measurement of clinical benefit endpoints including neurological and immunological functions. The iRANO guidelines put forth in this Review will evolve successively to improve their usefulness as further experience from immunotherapy trials in neuro-oncology accumulate+===== Progressive disease ===== 
 + 
 +Progressive disease can be diagnosed ​in the setting ​of immunotherapy ​in the following scenarios 1: 
 + 
 +==== Clinical features ==== 
 + 
 + 
 +significant clinical deterioration (not attributable ​to other non-tumour causes ​and not due to steroid decrease) 
 + 
 +==== Imaging features ==== 
 + 
 +>6 months of the current immunotherapeutic regime 
 +same as RANO progressive disease criteria 
 + 
 +≤6 months of the current immunotherapeutic regime 
 +requires a second scan confirming further progressive disease 3 months ​after the initial ​scan showing features of progressive ​disease 
 +during this interval, immunotherapy can continue if toxicity is minimal, at the discretion ​of treating clinicians 
 +---- 
 + 
 + 
 +iRANO is a multinational and multidisciplinary panel of neuro-oncology immunotherapy experts ​ 
 + 
 +Among patients who demonstrate imaging findings meeting [[RANO]] criteria for progressive disease within 6 months of initiating immunotherapy,​ including the development of new lesions, confirmation of radiographic progression on follow-up imaging is recommended provided that the patient is not significantly worse clinically. The proposed criteria also include guidelines for the use of corticosteroids. ​ 
 + 
 +They reviewed ​the role of advanced imaging techniques and the role of measurement of clinical benefit endpoints including neurological and immunological functions. The iRANO guidelines put forth in the Review ​of Okada et al. will evolve successively to improve their usefulness as further experience from immunotherapy trials in neuro-oncology accumulate
 ((Okada H, Weller M, Huang R, Finocchiaro G, Gilbert MR, Wick W, Ellingson BM, ((Okada H, Weller M, Huang R, Finocchiaro G, Gilbert MR, Wick W, Ellingson BM,
 Hashimoto N, Pollack IF, Brandes AA, Franceschi E, Herold-Mende C, Nayak L, Hashimoto N, Pollack IF, Brandes AA, Franceschi E, Herold-Mende C, Nayak L,
irano_criteria.txt · Last modified: 2018/11/12 22:12 by administrador