Norum Jan, Nieder Carsten
Department of Surgery, Finnmark Hospital, Hammerfest, Norway.
Department of Clinical Medicine, Faculty of Health Science, UiT - The Arctic University of Norway, Tromsø, Norway.
ESMO Open. 2018 Oct 2;3(6):e000406. doi: 10.1136/esmoopen-2018-000406. eCollection 2018.
Programmed death ligand 1 (PD-L1) targeting immunotherapies, as pembrolizumab and nivolumab, have significantly improved outcome in patients with non-small cell lung cancer (NSCLC). Tobacco smoking is the number one risk factor for lung cancer and is linked to 80%-90% of these cancers. Smoking during cancer therapy may influence on radiotherapy and chemotherapy outcome. We aimed to review the knowledge in immunotherapy.
A systematic review was done. We searched for documents and articles published in English language and registered in Cochrane Library, National Health Service (NHS) Centre for Reviews and Dissemination (CRD), Embase or Medline. The search terms were (A) (Lung cancer or NSCLC) with (pembrolizumab or nivolumab) with PD-L1 with (tobacco or smoking) and (B) Lung Neoplasms and Immunotherapy and (smoking cessation or patient compliance). 68 papers were detected and two more were added during review process (references) and six based on information from the manufacturers.
Nine papers were selected. High PD-L1 expression (≥50%) was correlated with current/ever smoking history in three studies. Six studies revealed a higher overall response rate (ORR) among current/former smokers. The ORR was generally (six studies) better among the current/former smoker group. So also when tumours had a molecular 'smoking signature' (one study). This was probably due to a higher mutational burden. In two studies, minor or no difference was revealed.One study (KEYNOTE-024) compared former and current smokers, and documented pembrolizumab being more effective among former smokers than current smokers.
Tobacco smoking patients with NSCLC generally have a higher PD-L1 tumour proportion score and experience a better ORR of immunotherapy than no smokers. There is little evidence on the effect of smoking during immunotherapy, but one study (KEYNOTE-024) may indicate survival gains of smoking cessation.
以程序性死亡配体1（PD-L1）为靶点的免疫疗法，如派姆单抗和纳武单抗，已显著改善了非小细胞肺癌（NSCLC）患者的治疗效果。吸烟是肺癌的首要危险因素，80%-90%的肺癌与之相关。癌症治疗期间吸烟可能会影响放疗和化疗效果。我们旨在综述免疫疗法方面的知识。
进行了一项系统综述。我们检索了以英文发表并在考克兰图书馆、英国国家医疗服务体系（NHS）综述与传播中心（CRD）、Embase或Medline注册的文献和文章。检索词为：（A）（肺癌或NSCLC）与（派姆单抗或纳武单抗）与PD-L1与（烟草或吸烟），以及（B）肺肿瘤与免疫疗法与（戒烟或患者依从性）。共检测到68篇论文，在综述过程中又补充了2篇（参考文献），还有6篇基于制造商提供的信息。
筛选出9篇论文。三项研究表明，高PD-L1表达（≥50%）与当前/既往吸烟史相关。六项研究显示，当前/既往吸烟者的总体缓解率（ORR）更高。在当前/既往吸烟者组中，ORR总体上（六项研究）更好。当肿瘤具有分子“吸烟特征”时也是如此（一项研究）。这可能是由于更高的突变负荷。两项研究显示差异较小或无差异。一项研究（KEYNOTE-024）比较了既往吸烟者和当前吸烟者，记录显示派姆单抗对既往吸烟者的疗效优于当前吸烟者。
NSCLC吸烟患者的PD-L1肿瘤比例评分通常较高，免疫疗法的ORR也优于不吸烟者。关于免疫治疗期间吸烟影响的证据很少，但一项研究（KEYNOTE-024）可能表明戒烟可提高生存率。
Zotero 插件