A rule written for a database
Educational use only. Not clinically reviewed58-year-old woman for trajectory recording, criterion-scope review, escalation to the treating team, evidence-boundary review, and handoff practice. About 8 simulated minutes.
What you will practise
- Record the clinical trajectory rather than the scan alone.
- Record what the response criteria do and do not govern.
- Call the treating team, which holds the decision.
- Refuse both continuing on the rule and stopping on the scan.
- Record bounded qualified-team treatment intent.
- Review the boundaries and read them in both directions.
- Hand off the direction and its rate, not the report.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Seymour L, Bogaerts J, Perrone A, et al; RECIST working group. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics. Lancet Oncol. 2017;18(3):e143-e152. The guideline modifies RECIST 1.1 for immunotherapy trials to ensure consistent design and data collection and to permit the ongoing collection of trial data and ultimate validation of the guideline. Unconfirmed progression allows continued treatment beyond RECIST 1.1 progression if the patient is clinically stable, with confirmatory imaging repeated 4 to 8 weeks later. The RECIST working group states that these are recommendations for data handling rather than patient management, and that they are not validated response criteria.
- Onesti CE, Frères P, Jerusalem G. Atypical patterns of response to immune checkpoint inhibitors: interpreting pseudoprogression and hyperprogression in decision making for patients’ treatment. J Thorac Dis. 2019;11(1):35-38. "Overall, the rate of pseudoprogression do not exceed 10% in patients treated with immune checkpoint inhibitors", with small numbers behind the favourable series. Hyperprogressive disease incidence in patients receiving immunotherapy ranges from 4% to 29% across studies, including 13.8% on immunotherapy against 5.1% on chemotherapy in one non-small-cell lung cancer series, with no effective treatment after hyperprogression reported in the literature. "It is crucial to recognize pseudoprogression from a real progression, to avoid both a premature discontinuation of an effective treatment and the delay of starting a new line of therapy."
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.