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Pseudoprogression — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyPseudoprogressionSCE Medical Oncology

At the first 12-week scan on pembrolizumab for metastatic melanoma, target lesions have enlarged by 24% and one small new lesion is seen. The patient is asymptomatic, ECOG 0 and laboratory results are stable. Under iRECIST, what is the best next step?

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Correct answer: A — Record iUPD, continue pembrolizumab if clinically stable and repeat imaging within 4–8 weeks

Initial RECIST progression during immunotherapy is immune unconfirmed progressive disease. In a clinically stable patient, iRECIST permits treatment beyond this first scan and requires confirmatory imaging 4–8 weeks later. Continuing is not automatic if the patient deteriorates; the stability in the stem is the key discriminator.

Reference: iRECIST guidelines for immunotherapy trials (Published March 2017): https://pmc.ncbi.nlm.nih.gov/articles/PMC5648544/