Bernichon Emilie, Tissot Claire, Bayle-Bleuez Sophie, Rivoirard Romain, Bouleftour Wafa, Forest Fabien, Tinquaut Fabien, Mery Benoite, Fournel Pierre
Institut de cancérologie Lucien-Newirth, Department of Medical Oncology, 108, bis avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
CHU de Saint-Étienne, Pneumology department, Saint-Étienne, France.
Bull Cancer. 2021 Mar;108(3):250-265. doi: 10.1016/j.bulcan.2020.10.010. Epub 2020 Dec 24.
Immunotherapy is the current treatment in non-small cell lung cancer (NSCLC). 20% of patients treated with immunotherapy have a prolonged response. What about the remaining 80%? How can we explain that some patients get no benefit from immunotherapy?
We retrospectively analyzed predictive factors of primary or secondary resistance to immunotherapy in NSCLC patients from 2 French hospitals between 2015 and 2018. Moreover, we evaluated whether PD1 inhibitor had an impact on the antitumor effects of salvage chemotherapy administered after immunotherapy. We chose to focus on taxanes.
Ninety-six patients were included in this cohort, 65(68%) patients were considered as having primary resistance and 31(32%) secondary resistance. Resistant populations did not differ. At immunotherapy initiation, median survival was 4.6 months for primary resistant patients (95%CI-4.6-6.8) and 15.6 months (95%CI-9.8-NA) for secondary resistant patients. The disease control rates with taxane were 15% in pre immunotherapy conditions vs 50% in post immunotherapy. Response rates improved regardless of the status of resistance.
This study enriches data about immunotherapy in real-life in NSCLC. Prognostic resistance factors still seem complicated to identify. The high rate of taxane responders in post immunotherapy in this retrospective cohort support the use of taxane in therapeutic escape.
免疫疗法是目前非小细胞肺癌（NSCLC）的治疗方法。接受免疫疗法治疗的患者中有20%具有延长的缓解期。那么其余80%的患者情况如何呢？我们如何解释一些患者无法从免疫疗法中获益呢？
我们回顾性分析了2015年至2018年间来自2家法国医院的NSCLC患者对免疫疗法原发性或继发性耐药的预测因素。此外，我们评估了PD1抑制剂对免疫疗法后给予的挽救性化疗的抗肿瘤效果是否有影响。我们选择重点研究紫杉烷类药物。
该队列纳入了96例患者，65例（68%）患者被认为具有原发性耐药，31例（32%）具有继发性耐药。耐药人群无差异。在开始免疫疗法时，原发性耐药患者的中位生存期为4.6个月（95%CI - 4.6 - 6.8），继发性耐药患者为15.6个月（95%CI - 9.8 - NA）。在免疫疗法前使用紫杉烷类药物时疾病控制率为15%，而免疫疗法后为50%。无论耐药状态如何，缓解率均有所提高。
本研究丰富了NSCLC免疫疗法在实际应用中的数据。预后耐药因素似乎仍然难以确定。在这个回顾性队列中，免疫疗法后紫杉烷类药物反应者的高比例支持在治疗逃逸中使用紫杉烷类药物。
