Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Clin Lung Cancer. 2020 Sep;21(5):e456-e463. doi: 10.1016/j.cllc.2020.02.022. Epub 2020 Mar 9.
Pulmonary sarcomatoid carcinoma (PSC) or pleomorphic carcinoma is a rare subtype of non-small cell lung cancer. Some reports have suggested the efficacy of checkpoint inhibitor immunotherapy for PSC. However, owing to the small number of patients in each report, it remains unclear whether programmed death receptor-ligand 1 (PD-L1) expression is predictive of tumor response or survival.
The English literature was systematically searched for articles published from 2015 to 2019 and reported on tumor response or progression-free survival (PFS) after immunotherapy for advanced PSC. In addition, our institutional electronic medical records were searched for eligible cases to be included. Pooled analyses were performed.
Analyses included 90 patients. Best tumor response was partial or complete response in 54.5%, stable disease 15.9%, and progressive disease in 29.6%. The median PFS was 7.0 months. Among 66 patients with reported PD-L1 expression, the level was <1% in 7 patients (10.6%), 1%-49% in 10 patients (15.2%), and ≥50% in 49 patients (74.2%). A positive relationship between PD-L1 level and tumor response was observed. Among 47 patients with a PD-L1 of ≥50%, 33 patients (70.2%) achieved response, compared with 5 of 10 patients (50%) with a PD-L1 of 1%-49% and 2 of 7 patients (28.6%) with a PD-L1 of <1% (P = .026). PFS was superior among patients with a PD-L1 of ≥1% compared with those with a PD-L1 of <1% (14.4 months vs. 2.7 months respectively; P = .04).
Among patients with advanced PSC, PD-L1 expression is significantly associated with increased tumor responses and improved PFS after checkpoint inhibitor immunotherapy.
肺肉瘤样癌（PSC）或多形性癌是一种罕见的非小细胞肺癌亚型。一些报告表明，检查点抑制剂免疫疗法对 PSC 有效。然而，由于每个报告中的患者数量较少，PD-L1 表达是否可预测肿瘤反应或生存仍不清楚。
系统地检索了 2015 年至 2019 年发表的英文文献，报道了晚期 PSC 接受免疫治疗后的肿瘤反应或无进展生存期（PFS）。此外，还检索了我们机构的电子病历，以纳入符合条件的病例。进行了汇总分析。
分析纳入了 90 例患者。最佳肿瘤反应为部分或完全缓解 54.5%，稳定疾病 15.9%，进展性疾病 29.6%。中位 PFS 为 7.0 个月。在报告 PD-L1 表达的 66 例患者中，7 例（10.6%）PD-L1 水平<1%，10 例（15.2%）PD-L1 水平为 1%-49%，49 例（74.2%）PD-L1 水平≥50%。观察到 PD-L1 水平与肿瘤反应之间存在正相关。在 47 例 PD-L1≥50%的患者中，33 例（70.2%）获得了缓解，而 PD-L1 为 1%-49%的 10 例患者中 5 例（50%）和 PD-L1<1%的 7 例患者中 2 例（28.6%）获得了缓解（P=0.026）。PD-L1≥1%的患者 PFS 优于 PD-L1<1%的患者（分别为 14.4 个月和 2.7 个月；P=0.04）。
在晚期 PSC 患者中，PD-L1 表达与检查点抑制剂免疫治疗后的肿瘤反应增加和 PFS 改善显著相关。
