Department of Oncology and Radiotherapy, Oulu University Hospital and MRC Oulu, P.B. 22, 90029, Oulu, Finland.
J Cancer Res Clin Oncol. 2020 Aug;146(8):2153-2160. doi: 10.1007/s00432-020-03217-7. Epub 2020 Apr 18.
Immune checkpoint inhibitors (ICIs) are approved in multiple indications for cancer care. Most of the clinical trials have not questioned shorter than until disease progression approaches. In this study, we present results from a cohort of multiple advanced cancers treated with restricted anti-PD-(L)1 therapy.
All patients with advanced cancers treated with anti-PD-(L)1 therapy outside clinical trials at Oulu University Hospital 2014-19 were retrospectively identified from pharmacy records. Clinical variables, treatment history and survival were collected.
106 patients with median age of 66 years with lung cancer (n = 45, 42.5%), melanoma (n = 30, 28.3%), renal and bladder cancers (GU cancers) (n = 26, 24.5%), head and neck (H&N) cancer (n = 4, 3.8%), and colorectal cancer (n = 1, 0.9%) were included in the study. The median (m) OS for the whole population was 14 months (CI 9.7-18.3), 9 months (CI 6.3-11.7) for patients with no IO-free period (n = 64, 62.1%), and 27.0 months (CI 20.6-33.4, p = 0.000001) for patients (n = 39) with IO-free period. The mIO-free survival was 10.0 months (CI 7.1-12.9) for the whole cohort, 8.0 months (CI 1.7-14.3) for lung cancer, 23.0 months (CI 2.6-43.4) for melanoma, and 14.0 months (CI 0.0-20.4) for GU cancer. From the IO-free cohort, 19 patients needed re-treatment during follow-up, of which 8 were re-challenged with anti-PD-(L)1 therapy. The clinical benefit rate of anti-PD-(L)1 re-challenge was 37.5%.
Our study shows that long IO-free periods can be achieved with limited duration of anti-PD-(L)1 therapy with excellent survival outcomes, and that anti-PD-(L)1 re-challenge is feasible in clinical practice.
免疫检查点抑制剂（ICI）已在多种癌症治疗适应证中获得批准。大多数临床试验并未质疑直到疾病进展接近时才停止治疗。在这项研究中，我们报告了一组接受限制使用抗 PD-(L)1 治疗的多种晚期癌症患者的结果。
从奥卢大学医院 2014-19 年的药房记录中回顾性确定了接受抗 PD-(L)1 治疗的晚期癌症患者的所有数据。收集了临床变量、治疗史和生存情况。
106 名年龄中位数为 66 岁的患者（肺癌 45 例，42.5%；黑色素瘤 30 例，28.3%；肾和膀胱癌[GU 癌症]26 例，24.5%；头颈部[H&N]癌症 4 例，3.8%；结直肠癌 1 例，0.9%）纳入研究。全人群的中位总生存期（OS）为 14 个月（95%CI：9.7-18.3），无免疫检查点抑制剂（IO）无进展期（n=64，62.1%）的患者为 9 个月（95%CI：6.3-11.7），而 IO 无进展期的患者（n=39）为 27.0 个月（95%CI：20.6-33.4，p=0.000001）。整个队列的中位 IO 无进展生存期（mIOFS）为 10.0 个月（95%CI：7.1-12.9），肺癌为 8.0 个月（95%CI：1.7-14.3），黑色素瘤为 23.0 个月（95%CI：2.6-43.4），GU 癌症为 14.0 个月（95%CI：0.0-20.4）。在 IO 无进展组中，19 名患者在随访期间需要重新治疗，其中 8 名接受了抗 PD-(L)1 再挑战治疗。抗 PD-(L)1 再挑战的临床获益率为 37.5%。
我们的研究表明，通过有限的抗 PD-(L)1 治疗持续时间，可以实现较长的 IO 无进展期，并获得极好的生存结果，并且在临床实践中抗 PD-(L)1 再挑战是可行的。
