PD-1/PD-L1抑制剂联合化疗可改善非小细胞肺癌脑转移患者的生存期。
PD-1/PD-L1 Inhibitor Combined with Chemotherapy Can Improve the Survival of Non-Small Cell Lung Cancer Patients with Brain Metastases.
作者信息
Sun Chenglong, Zhou Fei, Li Xuefei, Zhao Chao, Li Wei, Li Jiayu, Xiong Anwen, Yu Jia, Gao Guanghui, Wang Qi, Wu Fengying, Zhou Caicun
机构信息
Radiotherapy Department, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui, People's Republic of China.
Medical College of Soochow University, Suzhou 215123, Jiangsu, People's Republic of China.
出版信息
Onco Targets Ther. 2020 Dec 14;13:12777-12786. doi: 10.2147/OTT.S286600. eCollection 2020.
INTRODUCTION
Immune checkpoint inhibitor (ICI) monotherapy has limited efficacy in patients with non-small cell lung cancer (NSCLC) and brain metastases (BMs). With the wide use of ICI-based combinations, the efficacy of different ICI combination strategies in patients with NSCLC and BMs needs to be further elucidated.
METHODS
We retrospectively reviewed 526 patients with non-small cell lung cancer (NSCLC) treated with ICIs from January 2016 to December 2019 in the Shanghai Pulmonary Hospital. Patients with BMs treated with ICIs were further divided into two groups: those with BM prior to the ICI treatment (pBM group), and those with BM after the treatment (aBM group). We assessed intracranial progression-free survival (IPFS), systemic progression-free survival (SPFS), overall survival (OS), intracranial objective response rate (IORR), and intracranial disease control rate (IDCR).
RESULTS
We found 77 patients out of 526 with BMs; 69 presented the BMs prior to the ICI treatments and 8 showed BMs after the ICI treatments. In the pBM group, the median IPFS and SPFS were 7.39 months and 5.39 months, respectively. Combination therapy significantly improved both the IPFS (p=0.007) and the SPFS (p=0.007) when compared with monotherapy. Further analysis demonstrated that ICIs combined with chemotherapy significantly improved both the IPFS (p=0.009) and the SPFS (p=0.006) when compared with monotherapy. While ICIs combined with anti-angiogenic therapy improved the SPFS (p=0.005) but not the IPFS (p=0.139). The median OS was 27.43 months for patients in the pBM group. Further analyses suggested that combination treatment also improved the OS when compared with monotherapy (p=0.003). Subgroup analysis results showed that ICIs combined with chemotherapy led to better OS than ICIs monotherapy (p=0.006). Radiotherapy had no significant impact on survival (IPFS p=0.272, OS p=0.142) in the patients of the pBM group.
CONCLUSION
ICIs combined with chemotherapy demonstrated survival benefits over ICI monotherapy in patients with NSCLCs and BMs.
引言
免疫检查点抑制剂（ICI）单药治疗对非小细胞肺癌（NSCLC）合并脑转移（BM）患者的疗效有限。随着基于ICI的联合治疗广泛应用，不同ICI联合策略对NSCLC合并BM患者的疗效有待进一步阐明。
方法
我们回顾性分析了2016年1月至2019年12月在上海肺科医院接受ICI治疗的526例非小细胞肺癌患者。接受ICI治疗的BM患者进一步分为两组：ICI治疗前有BM的患者（pBM组）和治疗后出现BM的患者（aBM组）。我们评估了颅内无进展生存期（IPFS）、全身无进展生存期（SPFS）、总生存期（OS）、颅内客观缓解率（IORR）和颅内疾病控制率（IDCR）。
结果
我们在526例患者中发现77例有BM；69例在ICI治疗前出现BM，8例在ICI治疗后出现BM。在pBM组中，中位IPFS和SPFS分别为7.39个月和5.39个月。与单药治疗相比，联合治疗显著改善了IPFS（p = 0.007）和SPFS（p = 0.007）。进一步分析表明，与单药治疗相比，ICI联合化疗显著改善了IPFS（p = 0.009）和SPFS（p = 0.006）。而ICI联合抗血管生成治疗改善了SPFS（p = 0.005），但未改善IPFS（p = 0.139）。pBM组患者的中位OS为27.43个月。进一步分析表明，与单药治疗相比，联合治疗也改善了OS（p = 0.003）。亚组分析结果显示，ICI联合化疗的OS优于ICI单药治疗（p = 0.006）。放疗对pBM组患者的生存无显著影响（IPFS p = 0.272，OS p = 0.142）。
结论
对于NSCLC合并BM患者，ICI联合化疗比ICI单药治疗具有生存获益。
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