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Immune checkpoint blockade is now the standard-of-care multiple genitourinary malignancies, and radiographic pseudoprogression has emerged as a real, albeit rare, phenomenon. Emerging literature, including this report, indicate that clinical pseudoprogression is another important phenomenon that occurs when manifestations typical of clinical progression occur in the context of a patient having an anti-tumor immune response. With both radiographic and clinical pseudoprogression, the findings are caused by rapid proliferation of activated T lymphocytes. In this study, flow cytometry revealed a high proportion of activated CD8+ T lymphocytes based on surface markers (Figure 1), and cytokine analysis indicated high levels of IL-6 and IL-15. In summary, ascites during immune checkpoint therapy, particularly in the setting of peritoneal metastases, can result from T cell expansion. Pseudoprogression is rare, so clinical judgement remains paramount in deciding a course of action.
Written by: Randy F. Sweis, M.D. Department of Medicine, Section of Hematology/Oncology, Comprehensive Cancer Center, University of Chicago Medicine, Chicago, IL
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