免疫检查点抑制剂靶向治疗晚期或术后复发性非小细胞肺癌的预后因素
Prognostic factors of advanced or postoperative recurrent non-small cell lung cancer targeted with immune check point inhibitors.
作者信息
Ichiki Yoshinobu, Taira Akihiro, Chikaishi Yasuhiro, Matsumiya Hiroki, Mori Masataka, Kanayama Masatoshi, Nabe Yusuke, Shinohara Shinji, Kuwata Taiji, Takenaka Masaru, Oka Soichi, Hirai Ayako, Imanishi Naoko, Yoneda Kazue, Kuroda Koji, Fujino Yoshihisa, Tanaka Fumihiro
机构信息
Second Department of Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
出版信息
J Thorac Dis. 2019 Apr;11(4):1117-1123. doi: 10.21037/jtd.2019.04.41.
BACKGROUND
Although immune checkpoint inhibitors (ICIs) for non-small cell lung cancer (NSCLC) have been established as one of standard therapy, the prognostic factors of ICIs remain unclear, aside from the programed cell death-ligand 1 (PD-L1) expression of tumor cells. The aim of this study was to determine the prognostic factors of ICIs.
METHODS
We analyzed the clinicopathological data of 44 cases of advanced NSCLC targeted with ICIs in our hospital, between February 2016 and February 2018, in order to determine the prognostic factors of ICIs. We also reviewed the literature regarding ICIs.
RESULT
We retrospectively analyzed the 44 cases (26 nivolumab and 18 pembrolizumab cases). These patients were 38 men and 6 women, comprising 13 cases of adenocarcinoma, 29 squamous cell carcinoma and 2 unclassified types. Seven patients were using first-line therapy and while the others were using second-line therapy or later. Epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) mutations were negative in all the cases. The response rate and disease control rate were 20.5% and 51.3%, respectively. The median progression-free survival time and median survival time were 146 days and 257 days, respectively. We observed five severe adverse effects (AEs) (three cases of interstitial pneumonia, one of liver dysfunction and one of adrenal failure), that were resolved by steroid pulse therapy. In multivariate analyses, the Eastern Cooperative Oncology Group performance status (ECOG PS), pathological type, standardized uptake value (SUV) on positron emission tomography (PET), white blood cell (WBC) count, neutrophil, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase (LDH) and albumin were independently prognostic factors. There were no significant differences in the prognosis between nivolumab and pembrolizumab.
CONCLUSIONS
ICIs were effective in 44 treated NSCLC cases. Our analysis suggests that while ICIs are effective in treating patients, candidates must be carefully selected and cautiously observed.
背景
尽管免疫检查点抑制剂（ICIs）已成为非小细胞肺癌（NSCLC）的标准治疗方法之一，但除肿瘤细胞程序性死亡配体1（PD-L1）表达外，ICIs的预后因素仍不清楚。本研究的目的是确定ICIs的预后因素。
方法
我们分析了2016年2月至2018年2月期间我院44例接受ICIs治疗的晚期NSCLC患者的临床病理资料，以确定ICIs的预后因素。我们还回顾了有关ICIs的文献。
结果
我们回顾性分析了44例患者（26例使用纳武单抗和18例使用派姆单抗）。这些患者中男性38例，女性6例，包括13例腺癌、29例鳞状细胞癌和2例未分类类型。7例患者使用一线治疗，其余患者使用二线或更晚线治疗。所有病例的表皮生长因子受体（EGFR）突变和间变性淋巴瘤激酶（ALK）突变均为阴性。缓解率和疾病控制率分别为20.5%和51.3%。中位无进展生存期和中位生存期分别为146天和257天。我们观察到5例严重不良反应（AEs）（3例间质性肺炎、1例肝功能障碍和1例肾上腺功能衰竭），经类固醇脉冲治疗后得到缓解。在多因素分析中，东部肿瘤协作组体能状态（ECOG PS）、病理类型、正电子发射断层扫描（PET）上的标准化摄取值（SUV）、白细胞（WBC）计数、中性粒细胞、中性粒细胞与淋巴细胞比值（NLR）、乳酸脱氢酶（LDH）和白蛋白是独立的预后因素。纳武单抗和派姆单抗之间的预后无显著差异。
结论
ICIs对44例接受治疗的NSCLC患者有效。我们的分析表明，虽然ICIs在治疗患者方面有效，但必须仔细选择候选患者并谨慎观察。
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