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Characteristics of Exceptional or Super Responders to Cancer Drugs

  • Vinay Prasad
    Correspondence
    Correspondence: Address to Vinay Prasad, MD, MPH, Division of Medical Oncology, National Cancer Institute, National Institutes of Health, 10 Center Dr 10/12N226, Bethesda, MD 20892.
    Affiliations
    Division of Hematology Oncology in the Knight Cancer Institute, Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
    Search for articles by this author
  • Andrae Vandross
    Affiliations
    Division of Medical Oncology, University of California Los Angeles, Los Angeles
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Published:November 03, 2015DOI:https://doi.org/10.1016/j.mayocp.2015.08.017

      Abstract

      Objective

      To summarize case reports of exceptional and super responders already published in the biomedical literature.

      Patients and Methods

      We searched for published case reports or abstracts of exceptional or super responders to a cancer drug using PubMed and Google Scholar search engines. Pooling such reports is widely considered a promising research strategy and the subject of several ongoing investigations, including the National Cancer Institute's Exceptional Responders Initiative. All articles were read in full, including relevant references. We extracted clinical characteristics of exceptional or super responders, including age, tumor type, drug, genetic mutations, depth of response, duration of response, number of previous lines of therapy, duration of response to a previous line of therapy, and the number of patients treated similarly to identify the exceptional case. This study was performed between March 1, 2015, and April 30, 2015.

      Results

      Among 489 articles, 32 exceptional responders were identified. The most common malignancies described were renal cell cancer (5 of 32 [16%]) and urothelial carcinoma (4 of 32 [13%]). The use of targeted agents was common in these cases (26 of 32 [81%]), particularly inhibitors of the mTOR pathway (16 of 32 [50%]). The median duration of response among responders was 17.5 months, and 59% (19 of 32) of the patients were last known to be alive with continuing response or stable disease. Notably, 46% (12 of 26) of the patients had received 2 or more previous lines of therapy and 6 of the 32 cases (19%) did not report this information. Few authors report the number of patients treated similarly to observe the super response (12 of 32 [38%]).

      Conclusion

      Exceptional or super responders to cancer drugs have been described in the literature; however, there is incompleteness in the reporting of relevant data that may help clarify whether such responses are secondary to treatment or reflect underlying biology.

      Abbreviations and Acronyms:

      mTOR (mammalian target of rapamycin), NCI (National Cancer Institute)
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