Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan.
Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan.
Lung Cancer. 2021 Jan;151:60-68. doi: 10.1016/j.lungcan.2020.11.009. Epub 2020 Nov 15.
Pembrolizumab is recommended for patients with previously untreated non-small cell lung cancer (NSCLC) with a programmed death ligand 1 (PD-L1) tumor proportion score (TPS) of ≥1%. The KEYNOTE-024 study described the efficacy of pembrolizumab in patients with previously untreated NSCLC who had a PD-L1 TPS of at least 50 %. However, patients with untreated brain metastasis (BM) were excluded from many clinical trials. Therefore, we assessed the efficacy of pembrolizumab against BM of NSCLC with high tumor PD-L1 expression.
We retrospectively reviewed patients who received pembrolizumab as first-line treatment against NSCLC with PD-L1 TPS ≥ 50 % between March 2017 and September 2019. Treatment efficacy was compared between patients with (BM group) and without BM (non-BM group). In addition, the BM group was divided into patients who previously received treatment for BM before pembrolizumab (BM-T group) and those with no prior treatment for BM (BM-not T group).
Eighty-seven patients (23 BM group and 64 non-BM group) were assessable for efficacy. No significant differences in patient characteristics were found between the BM and non-BM groups, but proportion of patients with stage IV at diagnosis was significantly higher in the BM group. Median progression-free survival (PFS) (6.5 months vs. 7.0 months) and overall survival (OS) (21.6 months vs. 24.6 months) did not significantly differ between the two groups. The response rate of BM was 70 %. The BM group was subdivided into 13 patients in the BM-T group and 10 patients in the BM-not T group. No significant differences in patient characteristics were found between the two groups, but maximum diameter of BM and proportion of patients with symptomatic BM were significantly greater in the BM-T group. PFS and OS did not significantly differ between the two groups. The median PFS of BM was 13.6 months in the BM-T group and 18.6 months in the BM-not T group.
Pembrolizumab may be effective for BM caused by previously untreated NSCLC with high PD-L1 tumor expression.
对于程序性死亡配体 1（PD-L1）肿瘤比例评分（TPS）≥1%的未经治疗的非小细胞肺癌（NSCLC）患者，推荐使用派姆单抗进行治疗。KEYNOTE-024 研究描述了派姆单抗在 PD-L1 TPS 至少为 50%的未经治疗的 NSCLC 患者中的疗效。然而，许多临床试验都排除了未经治疗的脑转移（BM）患者。因此，我们评估了高肿瘤 PD-L1 表达的 NSCLC 患者使用派姆单抗治疗 BM 的疗效。
我们回顾性分析了 2017 年 3 月至 2019 年 9 月期间接受派姆单抗治疗 PD-L1 TPS≥50%的 NSCLC 患者。比较了有 BM（BM 组）和无 BM（非 BM 组）的患者的治疗效果。此外，BM 组还分为在使用派姆单抗前接受过 BM 治疗的患者（BM-T 组）和未接受过 BM 治疗的患者（BM-not T 组）。
87 例患者（23 例 BM 组和 64 例非 BM 组）可评估疗效。BM 组和非 BM 组患者的特征无显著差异，但 BM 组患者在诊断时为 IV 期的比例明显更高。两组患者的无进展生存期（PFS）（6.5 个月比 7.0 个月）和总生存期（OS）（21.6 个月比 24.6 个月）无显著差异。BM 的缓解率为 70%。BM 组进一步分为 BM-T 组 13 例和 BM-not T 组 10 例。两组患者的特征无显著差异，但 BM-T 组患者的 BM 最大直径和有症状 BM 的比例明显更大。两组患者的 PFS 和 OS 无显著差异。BM-T 组的中位 PFS 为 13.6 个月，BM-not T 组为 18.6 个月。
对于高 PD-L1 肿瘤表达的未经治疗的 NSCLC 引起的 BM，派姆单抗可能有效。
