Author’s reply to “Early progression after immune checkpoint inhibition: aligning assessment with disease distribution”

To the Editor We thank Kiracı for the thoughtful comments regarding the potential influence of assessment timing and endpoint definition on early-progression ascertainment in our study [1]. We agree that these are important considerations when interpreting real-world data, particularly because radiologic assessment was performed according to routine clinical practice rather than a protocol-mandated schedule. As suggested, we performed a sensitivity analysis restricted to the 160 patients with a recorded CT or MRI assessment within 90 days after immune checkpoint inhibitor initiation. Using the same multivariable model as in the original analysis, combined locoregional and distant disease remained significantly associated with early progression compared with distant-only disease (adjusted odds ratio [OR], 3.44; 95% confidence interval [CI], 1.26–9.39; P = .016), whereas locoregional-only disease was not significantly associated with early progression (adjusted OR, 1.41; 95% CI, 0.62–3.24; P = .414). The median times to the first CT or MRI assessment were 39 days for distant-only disease, 37 days for locoregional-only disease, and 34.5 days for combined locoregional and distant disease, with no significant difference among the three groups (Kruskal–Wallis P = .642).