Figure 1.
Figure 1. Changes in tumor burden, duration of therapy, and representative PET response in patients with RT receiving pembrolizumab. (A) The maximal percentage alteration in tumor burden from baseline in 9 RT patients. One patient (RS9), met the criteria for a PMR without having a 50% decrease in tumor burden but with a significant reduction of PET avidity. The color of each bar indicates whether a patient had prior ibrutinib therapy. (B) The response onset, and duration of therapy and DOR in RT patients. The length of the bar shows the time until the patient had a CR or a PR, along with the duration of the response and duration of therapy. Two patients (RS3 and RS7) who had SD, elected to discontinue the study in order to undergo alternative therapy. Three patients (RS1, RS2, and RS9) continued to receive pembrolizumab at the time of this report. Two patients (RS1 and RS2) had been added a signal inhibitor in addition to pembrolizumab (indicated by a blue arrow for the continuation phase) due to CLL progression in marrow (RS2) or a single locus RT progression detected on PET (RS1) (indicated by a solid red circle). RS1 had a DOR of 11 months for single-agent pembrolizumab and then received local radiation directed to one site of progression. He subsequently had a second CR and has maintained a CR with resumed pembrolizumab for 16 months of total therapy by the time of this report. RS2 had a DOR of 5 months for single-agent pembrolizumab and was then added idelalisib, and had pembrolizumab therapy for 12 months by the time of this report. RS6 had a DOR of ∼2 months before CLL marrow progression, leading to G3 thrombocytopenia. He came off therapy and received palliative care before the trial was amended to add a signal inhibitor. RS9 was in a sustained response of 3 months before the analysis cutoff. (C) The representative whole body PET images in RS2 at baseline prior to trial therapy and at the time point after 2 cycles of pembrolizumab treatment. The PET avid diseases were circled in these two PETs to compare the changes of PET-avid tumor. (D) The alteration of tumor burden and platelet count with the duration of therapy in RS2 during the single-agent therapy of pembrolizumab and the double-therapy of pembrolizumab with idelalisib. Arrow indicates the ongoing therapy. Trapezoid sign indicates a brief interruption of pembrolizumab due to thrombocytopenia.

Changes in tumor burden, duration of therapy, and representative PET response in patients with RT receiving pembrolizumab. (A) The maximal percentage alteration in tumor burden from baseline in 9 RT patients. One patient (RS9), met the criteria for a PMR without having a 50% decrease in tumor burden but with a significant reduction of PET avidity. The color of each bar indicates whether a patient had prior ibrutinib therapy. (B) The response onset, and duration of therapy and DOR in RT patients. The length of the bar shows the time until the patient had a CR or a PR, along with the duration of the response and duration of therapy. Two patients (RS3 and RS7) who had SD, elected to discontinue the study in order to undergo alternative therapy. Three patients (RS1, RS2, and RS9) continued to receive pembrolizumab at the time of this report. Two patients (RS1 and RS2) had been added a signal inhibitor in addition to pembrolizumab (indicated by a blue arrow for the continuation phase) due to CLL progression in marrow (RS2) or a single locus RT progression detected on PET (RS1) (indicated by a solid red circle). RS1 had a DOR of 11 months for single-agent pembrolizumab and then received local radiation directed to one site of progression. He subsequently had a second CR and has maintained a CR with resumed pembrolizumab for 16 months of total therapy by the time of this report. RS2 had a DOR of 5 months for single-agent pembrolizumab and was then added idelalisib, and had pembrolizumab therapy for 12 months by the time of this report. RS6 had a DOR of ∼2 months before CLL marrow progression, leading to G3 thrombocytopenia. He came off therapy and received palliative care before the trial was amended to add a signal inhibitor. RS9 was in a sustained response of 3 months before the analysis cutoff. (C) The representative whole body PET images in RS2 at baseline prior to trial therapy and at the time point after 2 cycles of pembrolizumab treatment. The PET avid diseases were circled in these two PETs to compare the changes of PET-avid tumor. (D) The alteration of tumor burden and platelet count with the duration of therapy in RS2 during the single-agent therapy of pembrolizumab and the double-therapy of pembrolizumab with idelalisib. Arrow indicates the ongoing therapy. Trapezoid sign indicates a brief interruption of pembrolizumab due to thrombocytopenia.

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