Department of Pneumology, University Hospital of Bordeaux, 33604 Pessac, France.
Biostatistics Unit, Institut Claudius Regaud, IUCT-O, Toulouse, France.
Respir Med Res. 2020 Nov;78:100788. doi: 10.1016/j.resmer.2020.100788. Epub 2020 Aug 28.
Anti Programmed Death-ligand (PD1/PD-L1) directed immune-checkpoint-inhibitors (ICI) are widely used to treat patients with advanced non-small cell lung cancer (NSCLC) who progress after first line chemotherapy. The best strategy after early progression under first line has not been specifically studied.
We conducted a multicenter, retrospective study including all consecutive NSCLC patients progressing within the first 3 months following introduction of first-line chemotherapy and being treated with second line ICI monotherapy or chemotherapy between March 2010 and November 2017. We analysed the clinicopathological data and outcome under second line chemotherapy vs. second line ICI: objective response rate (ORR), progression-free survival (PFS), overall survival (OS.
We identified 176 patients with refractory disease, 99 who received subsequent immunotherapy and 77 undergoing chemotherapy. The 2 populations were comparable regarding the main prognostic criteria, median age was 60, main histology was adenocarcimoma (68.2%). PFS was not significantly different between both treatments 1.9 [1.8-2.1] versus 1.6 month [1.4-2.0] (P=0.125). Compared to chemotherapy, ICI treated patients had a superior OS (P=0.03) (Median [95% CI] OS 4.6 [2.8-6.7] versus 4.2 months [3.4-5.9] and a non-significant improvement in ORR (17.2% versus 7.9%, respectively, P=0.072). Poor performance status (ECOG PS≥2) and a higher number of metastatic sites (≥3) were associated with poorer prognosis. KRAS-mutated patients did not seem to benefit more from ICI than chemotherapy.
ICI appears to be the preferred second-line treatment for patients who are refractory to first line chemotherapy.
抗程序性死亡配体（PD1/PD-L1）定向免疫检查点抑制剂（ICI）广泛用于治疗一线化疗后进展的晚期非小细胞肺癌（NSCLC）患者。在一线治疗早期进展后，最佳策略尚未专门研究。
我们进行了一项多中心、回顾性研究，纳入了 2010 年 3 月至 2017 年 11 月期间所有在一线化疗后 3 个月内进展并接受二线 ICI 单药或化疗治疗的连续 NSCLC 患者。我们分析了二线化疗与二线 ICI 的临床病理数据和结果：客观缓解率（ORR）、无进展生存期（PFS）、总生存期（OS）。
我们确定了 176 例难治性疾病患者，其中 99 例接受了后续免疫治疗，77 例接受了化疗。这两个人群在主要预后标准方面具有可比性，中位年龄为 60 岁，主要组织学类型为腺癌（68.2%）。两种治疗方法的 PFS 无显著差异（1.9 [1.8-2.1]与 1.6 个月[1.4-2.0]；P=0.125）。与化疗相比，ICI 治疗患者的 OS 更优（P=0.03）（中位[95%CI]OS 4.6 [2.8-6.7]与 4.2 个月[3.4-5.9]，ORR 略有改善（17.2%与 7.9%，分别，P=0.072）。较差的表现状态（ECOG PS≥2）和更多的转移部位（≥3）与预后较差相关。KRAS 突变患者似乎并未从 ICI 中获益更多化疗。
ICI 似乎是对一线化疗耐药的患者的首选二线治疗。
