化疗联合免疫检查点抑制剂与免疫检查点抑制剂单药治疗晚期和转移性非小细胞肺癌的比较。

Comparison of a combination of chemotherapy and immune checkpoint inhibitors and immune checkpoint inhibitors alone for the treatment of advanced and metastatic non-small cell lung cancer.

机构信息

Department of Thoracic Medicine, Division of Lung Cancer and Interventional Bronchoscopy, Chang Gung Memorial Hospital, Taipei, Taiwan.

Department of Computing, Data Science Institute, Imperial College London, London, UK.

出版信息

Thorac Cancer. 2019 May;10(5):1158-1166. doi: 10.1111/1759-7714.13057. Epub 2019 Apr 5.

BACKGROUND

Single agent immune checkpoint inhibitors (ICIs) improve survival outcomes compared to chemotherapy for advanced non-small cell lung cancer (NSCLC), but treatment efficacy widely varies. The combination of ICIs with chemotherapy has shown promising efficacy over chemotherapy alone; however, whether this strategy is superior to single agent ICIs for the treatment of advanced NSCLC remains unknown.

METHODS

The records of 109 patients with advanced NSCLC who were administered at least one cycle of ICIs were retrospectively reviewed. Patients were grouped based on the presence or absence of a chemotherapy treatment combination. Efficacy and survival outcomes were analyzed.

RESULT

Sixty-nine (58.0%) patients received single agent ICIs (ICI group) and 50 (42.0%) received ICIs and chemotherapy (ICC group). The median (3.2 vs. 3.0 months; P = 0.025) and one-year (34.5 vs. 9.6%; P = 0.026) progression-free survival (PFS) rates were significantly better in the ICC than in the ICI group. The superior efficacy of ICC remained in the propensity score matched pairs (median PFS 3.2 vs. 2.6 months, P = 0.032; 1-year PFS 35.2 vs. 7.6%; P = 0.035). Eastern Cooperative Oncology Group performance status 0-1 (HR 0.37, 95% CI 0.22-0.62; P < 0.001) and the ICC group (HR 0.56, 95% CI 0.34-0.94; P = 0.028) were predictive of PFS. Subgroup-to-chemotherapy interaction revealed improved risk reduction for adenocarcinoma and EGFR mutation.

CONCLUSION

Combing chemotherapy with ICIs improved treatment efficacy over ICIs alone. The additional efficacy of chemotherapy may differ between histological subtypes and EGFR mutation status.

背景

与化疗相比，单药免疫检查点抑制剂（ICI）可改善晚期非小细胞肺癌（NSCLC）患者的生存结局，但治疗效果差异较大。ICI 联合化疗的疗效优于单纯化疗，但对于晚期 NSCLC 的治疗，该策略是否优于单药 ICI 尚不清楚。

方法

回顾性分析了 109 例至少接受过一个周期 ICI 治疗的晚期 NSCLC 患者的记录。根据是否联合化疗，将患者分为两组。分析疗效和生存结局。

结果

69 例（58.0%）患者接受了单药 ICI（ICI 组），50 例（42.0%）患者接受了 ICI 联合化疗（ICC 组）。ICC 组的中位（3.2 个月比 3.0 个月；P=0.025）和 1 年无进展生存（PFS）率（34.5%比 9.6%；P=0.026）明显优于 ICI 组。在倾向评分匹配的对中，ICC 的疗效优势仍然存在（中位 PFS：3.2 个月比 2.6 个月，P=0.032；1 年 PFS：35.2%比 7.6%，P=0.035）。东部肿瘤协作组（ECOG）体能状态 0-1（HR 0.37，95%CI 0.22-0.62；P<0.001）和 ICC 组（HR 0.56，95%CI 0.34-0.94；P=0.028）是 PFS 的预测因素。亚组间与化疗的交互作用显示，腺癌和 EGFR 突变患者的风险降低更为显著。