BC Cancer-Victoria, Victoria, BC.
University of Victoria, Department of Mathematics and Statistics, Victoria, BC.
Curr Oncol. 2020 Apr;27(2):76-82. doi: 10.3747/co.27.5495. Epub 2020 May 1.
Although PD-1 antibodies (PD1 Ab) are the standard of care for advanced non-small-cell lung cancer (ansclc), most patients will progress. We compared survival outcomes for patients with ansclc who received systemic therapy (st) after progression and for those who did not. Additionally, clinical characteristics that predicted receipt of st after PD1 Ab failure were evaluated.
All patients with ansclc in British Columbia initiated on nivolumab or pembrolizumab between June 2015 and November 2017, with subsequent progression, were identified. Eligibility criteria for additional st included an Eastern Cooperative Oncology Group (ecog) performance status (ps) of 3 or less and survival for more than 30 days from the last PD1 Ab treatment. Post-progression survival (pps) was assessed by landmark analysis. Baseline characteristics associated with pps were identified by multivariable analysis.
Of 94 patients meeting the eligibility criteria, 33 received st after progression. In 75.6%, a PD1 Ab was received as first- or second-line treatment. The most common sts were erlotinib (36.4%) and docetaxel (27.3%). No statistically significant difference in median pps was observed between patients who did and did not receive st within 30 days of their last PD1 Ab treatment (6.9 months vs. 3.6 months, log-rank = 0.15.) In multivariable analysis, factors associated with increased pps included an ecog ps of 0 or 1 compared with 2 or 3 [hazard ratio (hr): 0.42; 95% confidence interval (ci): 0.24 to 0.73; = 0.002] and any response compared with no response to PD1 Ab (hr: 0.54; 95% ci: 0.33 to 0.90; = 0.02).
In this cohort, only 35.1% of patients eligible for post-PD1 Ab therapy received st. Post-progression survival was not significantly affected by receipt of post-progression therapy. Prospective trials are needed to clarify the benefit of post-PD1 Ab treatments.
尽管 PD-1 抗体（PD1Ab）是晚期非小细胞肺癌（ansclc）的标准治疗方法，但大多数患者仍会进展。我们比较了进展后接受系统治疗（st）和未接受 st 的 ansclc 患者的生存结局。此外，还评估了预测 PD1Ab 失败后接受 st 的临床特征。
确定了 2015 年 6 月至 2017 年 11 月期间在不列颠哥伦比亚省开始接受纳武单抗或帕博丽珠单抗治疗且随后进展的所有 ansclc 患者。接受额外 st 的资格标准包括东部合作肿瘤学组（ecog）表现状态（ps）为 3 或更低，并且从最后一次 PD1Ab 治疗后生存时间超过 30 天。通过 landmark 分析评估进展后生存（pps）。通过多变量分析确定与 pps 相关的基线特征。
符合纳入标准的 94 例患者中，有 33 例在进展后接受了 st。在 75.6%的患者中，PD1Ab 作为一线或二线治疗药物。最常见的 st 是厄洛替尼（36.4%）和多西他赛（27.3%）。在最近一次 PD1Ab 治疗后 30 天内接受或未接受 st 的患者的中位 pps 无统计学差异（6.9 个月 vs. 3.6 个月，对数秩检验=0.15）。多变量分析显示，与 PS 为 2 或 3 相比，PS 为 0 或 1（风险比[HR]：0.42；95%置信区间[CI]：0.24 至 0.73；P=0.002）和对 PD1Ab 有任何反应（HR：0.54；95%CI：0.33 至 0.90；P=0.02）与 pps 增加相关。
在本队列中，仅有 35.1%符合 PD1Ab 治疗后治疗条件的患者接受了 st。进展后治疗对进展后生存无显著影响。需要前瞻性试验来阐明 PD1Ab 治疗后的获益。
