Department of Pharmacy, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, Yamashina-ku, Kyoto, Japan.
Cancer Control. 2020 Jan-Dec;27(4):1073274820977200. doi: 10.1177/1073274820977200.
Immune-checitors have been established as a novel standard treatment for non-small cell lung cancer (NSCLC). The aim of this study was to identify factors associated with efficacy and nivolumab-related interstitial pneumonia in NSCLC by evaluating clinical data at the initiation of and during treatment.
We retrospectively reviewed the medical records of patients who underwent treatment with nivolumab between October 2015 and December 2017. Using pretreatment patient data, we investigated factors associated with overall survival (OS) and the onset of nivolumab-related pneumonitis. We investigated serum biochemistry during treatment to identify the determinants associated with progressive disease (PD) and the onset of nivolumab-related pneumonitis.
A total of 94 patients were included. Eleven patients continued treatment, and 54 patients were diagnosed with progressive disease. Nivolumab-related pneumonitis occurred in 15 patients. A pretreatment Eastern Cooperative Oncology Group Performance Status (ECOG PS) = 0 was linked to significantly longer OS than ECOG PS = 1 (median: 20.1 vs. 6.5 months, respectively; < 0.001). There was a higher incidence of nivolumab-related pneumonitis in patients with a history of interstitial pneumonia than in those without it ( = 0.008). During treatment, the level of albumin gradually decreased prior to PD and onset of nivolumab-related pneumonitis.
These results suggest that the pretreatment ECOG PS is the determining factor that is associated with OS, whereas history of interstitial pneumonia is the factor associated with nivolumab-related pneumonitis. A decrease in albumin during treatment may be associated with both PD and nivolumab-related pneumonitis.
免疫检查点抑制剂已成为非小细胞肺癌（NSCLC）的一种新的标准治疗方法。本研究旨在通过评估治疗开始时和治疗期间的临床数据，确定与 NSCLC 疗效和 nivolumab 相关间质性肺炎相关的因素。
我们回顾性地审查了 2015 年 10 月至 2017 年 12 月期间接受 nivolumab 治疗的患者的病历。使用预处理患者数据，我们研究了与总生存期（OS）和 nivolumab 相关肺炎发病相关的因素。我们在治疗期间检查血清生化，以确定与进展性疾病（PD）和 nivolumab 相关肺炎发病相关的决定因素。
共纳入 94 例患者。11 例患者继续治疗，54 例患者被诊断为进展性疾病。15 例患者发生 nivolumab 相关肺炎。预处理东部合作肿瘤学组表现状态（ECOG PS）= 0 与 ECOG PS = 1 相比，OS 明显更长（中位数：20.1 与 6.5 个月，分别；<0.001）。有间质性肺炎病史的患者发生 nivolumab 相关肺炎的发生率高于无间质性肺炎病史的患者（= 0.008）。在治疗期间，白蛋白水平在 PD 发生和 nivolumab 相关肺炎发生之前逐渐下降。
这些结果表明，预处理 ECOG PS 是与 OS 相关的决定因素，而间质性肺炎病史是与 nivolumab 相关肺炎相关的因素。治疗期间白蛋白的减少可能与 PD 和 nivolumab 相关肺炎都有关。
