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1 PSPDs were described under ICI in patients treated for MSI/dMMR mCRC, more frequently with anti-PD1 alone compare to anti-PD1+antiCTL-4. We are surprised that no cases were reported in their study. Confirming PD after iUPD requires new imaging with further progression. The major change from RECIST 1.1 to iRECIST is the concept of “unconfirmed progressive disease’ (iUPD). The existence and frequency of such a phenomenon is crucial in terms of clinical practice, as it would support the continuation of ICI beyond progression and the systematic use of iRECIST criteria to detect it, especially during the three first months of therapy. We would like to question the authors on the issue of pseudoprogression (PSPD). In this population, ETS and depth of response could help to better select patients for intensification/de-intensification and in our opinion, to better define the duration of treatment. In their article, Fucà et al highlight that early tumor shrinkage (ETS) and depth of response predict prognosis of patients with metastatic colorectal cancer (mCRC) microsatellite instability (MSI-H)/deficient mismatch repair (dMMR) treated by immune checkpoint inhibitors (ICI). We read the article written by Fucà et al 1 with great interest. In conclusion, if the first evaluation is made during the first 3 months of treatment, using iRECIST criteria seems mandatory to avoid stopping treatment prematurely, especially in patients receiving anti-PD1 alone. Second, the first imaging was done after 8–9 weeks of treatment in Fucà’s article, which may be late to detect PSPD.

First, Fucà et al use RECIST 1.1 criteria for radiological evaluation.

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These differences between the two series could be probably explained by the following points.

Conversely, in Fucà’s article, no PSDP was observed and the patients with primary radiological progression (21.7%) had a poor overall survival.

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Of 12 patients with PSPD, 8 secondary achieved an objective response and were alive and free of progression at the data lock. In a cohort of 123 patients treated with anti-PD1±antiCTL-4 for MSI/dMMR mCRC, we reported 12 patients with PSPD, representing 10% of the cohort.

PSPDs were described under ICI in patients treated for MSI/dMMR mCRC. We are surprised that no cases of pseudoprogression (PSPD) were reported in their study. In their article, Fucà et al highlight that early tumor shrinkage and depth of response predict the prognosis of patients with metastatic colorectal cancer (mCRC) microsatellite instability (MSI-H)/deficient mismatch repair (dMMR) treated by immune checkpoint inhibitors (ICI).

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