Department of Oncology and Haematology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
University of Bern, Bern, Switzerland.
Cancer Immunol Immunother. 2018 Dec;67(12):1825-1832. doi: 10.1007/s00262-018-2239-4. Epub 2018 Aug 31.
Response to immune checkpoint inhibitors depends on tumor intrinsic properties and also on host factors in the tumour microenvironment including the presence of immune cells (IC). We hypothesized that nivolumab efficacy varies across different metastatic sites.
We retrospectively analyzed computed tomography scans of patients with metastatic non-small cell lung carcinoma (NSCLC) receiving nivolumab. RECIST 1.1 criteria were applied to assess the overall response rate (ORR) and organ-specific response rate (OSRR).
We analyzed 52 patients including 44% females, 58% adenocarcinoma and 8% never smokers. Involved organs had target-lesions in the lung (42%), liver (25%), lymph nodes (56%) and soft tissue (13%) and non-target lesions in the bones (23%). ORR and disease control rate (DCR) were 20% and 45%, respectively. Median overall survival, progression-free survival and duration of response were 11.9, 2.3 and 10.3 months. OSRR and organ-specific DCR (OSDCR) were 28% and 90% in lymph nodes, 8% and 54 in the liver, and 9% and 55% in lung metastases. Nine out of 12 patients with bone metastases had progressive lesions. The cumulative incidence probability of organ-specific progression at 6 months was 14% in lymph nodes, 42% in the liver, 36% in lung metastases and 26% in the primary tumor, 29% in soft tissue and 33% in adrenal metastases.
In conclusion, the efficacy of immunotherapy is dependent on the metastatic location. Treatment appears more active in lymph nodes compared to other organ sites such as liver, adrenals and bone. Future strategies may include additional local treatment in case of oligoprogression in these organs in patients with otherwise sustained treatment benefit.
免疫检查点抑制剂的反应取决于肿瘤内在特性，也取决于肿瘤微环境中的宿主因素，包括免疫细胞（IC）的存在。我们假设纳武利尤单抗在不同转移部位的疗效不同。
我们回顾性分析了接受纳武利尤单抗治疗的转移性非小细胞肺癌（NSCLC）患者的计算机断层扫描。应用 RECIST 1.1 标准评估总体缓解率（ORR）和器官特异性缓解率（OSRR）。
我们分析了 52 例患者，包括 44%的女性，58%为腺癌，8%为从不吸烟者。受累器官的靶病灶位于肺部（42%）、肝脏（25%）、淋巴结（56%）和软组织（13%），非靶病灶位于骨骼（23%）。ORR 和疾病控制率（DCR）分别为 20%和 45%。中位总生存期、无进展生存期和缓解持续时间分别为 11.9、2.3 和 10.3 个月。淋巴结的 OSRR 和器官特异性 DCR（OSDCR）分别为 28%和 90%，肝脏为 8%和 54%，肺部转移瘤为 9%和 55%。12 例骨转移患者中有 9 例出现进展性病变。6 个月时器官特异性进展的累积发生率分别为淋巴结 14%、肝脏 42%、肺部转移瘤 36%、原发性肿瘤 26%、软组织 29%和肾上腺转移瘤 33%。
总之，免疫治疗的疗效取决于转移部位。与其他器官部位（如肝脏、肾上腺和骨骼）相比，治疗在淋巴结中似乎更有效。未来的策略可能包括在这些器官出现寡进展的情况下，对患者进行额外的局部治疗，以维持治疗获益。
