免疫相关不良反应与接受抗 PD-1/PD-L1 治疗的患者无进展生存期的改善相关。
Immune-related adverse events are linked with improved progression-free survival in patients receiving anti-PD-1/PD-L1 therapy.
机构信息
Division of Hematology and Oncology, Medical University of South Carolina, 39 Sabin Street, MSC 635, Charleston, SC, USA.
Department of Pharmacy, Medical University of South Carolina, 150 Ashley Avenue, Charleston, SC, USA.
出版信息
Semin Oncol. 2018 Jun;45(3):156-163. doi: 10.1053/j.seminoncol.2018.07.003. Epub 2018 Oct 19.
BACKGROUND
Immune-related adverse events (irAEs) are commonly encountered, when using programmed death-1/programmed death-ligand-1 (anti-PD-1/PD-L1) therapy and are often managed with corticosteroids. The effect of irAEs, particularly when steroids are required, on patient survival is not well established.
METHODS
In this retrospective analysis, data for 157 patients with various tumor types treated with anti-PD-1/PD-L1 therapy were obtained. Kaplan-Meier and Cox regression analyses were used to assess the effect of irAEs and corticosteroids on progression-free survival (PFS).
RESULTS
A total of 45 irAEs were recorded for 157 patients. Twenty-one patients received systemic corticosteroids. Patients who developed irAEs, as well as those who received systemic corticosteroids, had improved PFS by Kaplan-Meier estimate. Multivariate Cox regression showed that irAEs were associated with improved PFS (hazard ratio of 0.33, P <0.001) which persisted even with use of systemic corticosteroids (hazard ratio of 0.38, P = 0.03).
CONCLUSIONS
irAEs are associated with improved PFS in patients receiving anti-PD-1/PD-L1 therapy. This association does not appear to be altered by the use of systemic corticosteroids.
背景
使用程序性死亡受体 1/程序性死亡受体配体 1（抗 PD-1/PD-L1）治疗时，常发生免疫相关不良反应（irAEs），常采用皮质类固醇治疗。irAEs 对患者生存的影响，尤其是需要使用类固醇时的影响，尚未得到充分证实。
方法
本回顾性分析纳入了 157 例接受抗 PD-1/PD-L1 治疗的各种肿瘤类型患者的数据。采用 Kaplan-Meier 和 Cox 回归分析评估 irAEs 和皮质类固醇对无进展生存期（PFS）的影响。
结果
157 例患者共记录到 45 例 irAEs，21 例患者接受了全身皮质类固醇治疗。Kaplan-Meier 估计显示，发生 irAEs 和接受全身皮质类固醇治疗的患者 PFS 得到改善。多变量 Cox 回归显示，irAEs 与改善的 PFS 相关（风险比为 0.33，P<0.001），即使使用全身皮质类固醇治疗，这种相关性仍然存在（风险比为 0.38，P=0.03）。
结论
在接受抗 PD-1/PD-L1 治疗的患者中，irAEs 与改善的 PFS 相关。这种关联似乎不受全身皮质类固醇的影响。
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