Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Ariake 3-8-31, Koto, Tokyo, 1358550, Japan.
Hematology/Respiratory Medicine, Kanazawa University Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa, Ishikawa, Japan.
Int J Clin Oncol. 2020 Jan;25(1):67-73. doi: 10.1007/s10147-019-01537-4. Epub 2019 Sep 10.
Chemoradiotherapy (CRT) is the standard treatment for locally advanced non-small cell lung cancer (NSCLC). Recently, anti-PD-1 antibody therapy became a key treatment for stage IV NSCLC as the combination of immune checkpoint inhibitors (ICIs) and platinum doublet chemotherapy. However, the efficacy and toxicity of anti-PD-1 therapy for recurrence after CRT in stage III NSCLC are not well examined.
Patients who received anti-PD-1 therapy for recurrence after CRT were identified in our clinical database. The safety and efficacy of anti-PD-1 therapy were retrospectively analyzed.
From March 1, 2013 to April 30, 2018, there were 20 patients who received anti-PD-1 therapy for recurrence after CRT. The median duration from CRT to initial anti-PD-1 therapy was 9.3 months. 12 patients (60%) were alive and 7 patients (35%) were still receiving anti-PD-1 therapy at the data cutoff point (median follow-up, 13.5 months). The ORR for anti-PD-1 therapy was 45.0%. Median progression-free survival (PFS) and overall survival (OS) from initiation of anti-PD-1 therapy was 8.4 months and 26.2 months, respectively. PFS in patients who had a short interval from last CRT to initial anti-PD-1 therapy seemed to have better outcomes (duration from last CRT to initial anti-PD-1 therapy < 9.3 months vs. ≥ 9.3 months; median PFS, 17.0 months vs. 4.9 months). Grade 3 or 4 immune-related adverse events occurred in 5% of patients. Only grade 1 pneumonitis was observed.
The efficacy of anti-PD-1 therapy for recurrence after CRT in stage III NSCLC might better than in stage IV NSCLC. The duration from CRT to initial anti-PD-1 therapy might be related to efficacy.
放化疗（CRT）是局部晚期非小细胞肺癌（NSCLC）的标准治疗方法。最近，抗 PD-1 抗体治疗成为 IV 期 NSCLC 的关键治疗方法，因为免疫检查点抑制剂（ICI）和铂类双药化疗的联合应用。然而，抗 PD-1 治疗在 III 期 NSCLC 放化疗后复发中的疗效和毒性尚未得到充分研究。
在我们的临床数据库中确定了接受抗 PD-1 治疗用于 CRT 后复发的患者。回顾性分析抗 PD-1 治疗的安全性和疗效。
2013 年 3 月 1 日至 2018 年 4 月 30 日，有 20 例患者在 CRT 后复发时接受了抗 PD-1 治疗。从 CRT 到初始抗 PD-1 治疗的中位时间为 9.3 个月。12 例（60%）患者存活，7 例（35%）患者在数据截止点（中位随访时间为 13.5 个月）仍在接受抗 PD-1 治疗。抗 PD-1 治疗的客观缓解率（ORR）为 45.0%。从开始抗 PD-1 治疗开始的中位无进展生存期（PFS）和总生存期（OS）分别为 8.4 个月和 26.2 个月。从最后一次 CRT 到开始抗 PD-1 治疗的间隔较短的患者的 PFS 似乎有更好的结果（最后一次 CRT 到开始抗 PD-1 治疗的间隔<9.3 个月与≥9.3 个月；中位 PFS，17.0 个月与 4.9 个月）。3 级或 4 级免疫相关不良事件发生率为 5%。仅观察到 1 级肺炎。
抗 PD-1 治疗在 III 期 NSCLC 放化疗后复发中的疗效可能优于 IV 期 NSCLC。从 CRT 到初始抗 PD-1 治疗的时间可能与疗效有关。
