Nie Nai-Fu, Liu Zhu-Lin, Feng Ming-Xia, Liu Lan, Luo Nuo, Li Li, He Yong
Department of Respiratory Disease, Daping Hospital, Army Medical University, Chongqing, China.
Department of Respiratory Disease, Daping Hospital, Army Medical University, Chongqing, China. Email:
Ann Palliat Med. 2021 Jan;10(1):210-219. doi: 10.21037/apm-20-2279.
Immune checkpoint inhibitors (ICIs) have become the standard treatment for patients with advanced non-small cell lung cancer (NSCLC). However, the safety and efficacy of ICIs in severe advanced NSCLC patients with poor performance status (PS) are still unclear.
In the current study, we report a retrospective case series of three critically ill NSCLC patients with poor PS treated with immunotherapy in our hospital, and discussed these cases with reference to the existing literature and guidelines.
Before treatment, the Eastern Cooperative Oncology Group (ECOG) PS scores of all three patients were 4, while programmed cell death protein ligand-1 (PD-L1) was strongly expressed (over 50%). After initiating anti-programmed cell death 1 (PD-1)/PD-L1 agents, the PS score of the three patients improved rapidly to 0-1 in a short time. A Lazarus type response was observed in all patients. There were no grade 3-4 immune-related adverse events (irAEs) in any of the patients, and only one patient developed rash (grade 2 irAE) and hypothyroidism (grade 2 irAE). The best response across all three patients was partial response (PR). As of the latest follow-up date on June 10, 2020, two patients are still alive, with the other having died on January 14, 2020, whose progression-free survival (PFS) and overall survival (OS) were 11 and 16 months, respectively.
Immunotherapy is still an effective and low-toxicity option for severe advanced NSCLC patients with poor PS. Lazarus type response may occur, especially in patients whose PD-L1 is strongly expressed (≥50%). However, a greater amount of real-world data or randomized clinical trials are needed in this setting.
免疫检查点抑制剂（ICIs）已成为晚期非小细胞肺癌（NSCLC）患者的标准治疗方法。然而，ICIs在体能状态（PS）较差的重度晚期NSCLC患者中的安全性和有效性仍不明确。
在本研究中，我们报告了我院收治的3例PS较差的重症NSCLC患者接受免疫治疗的回顾性病例系列，并参照现有文献和指南对这些病例进行了讨论。
治疗前，所有3例患者的东部肿瘤协作组（ECOG）PS评分均为4分，而程序性细胞死亡蛋白配体1（PD-L1）呈强表达（超过50%）。在开始使用抗程序性细胞死亡蛋白1（PD-1）/PD-L1药物后，3例患者的PS评分在短时间内迅速改善至0-1分。所有患者均观察到拉撒路型反应。所有患者均未出现3-4级免疫相关不良事件（irAEs），只有1例患者出现皮疹（2级irAE）和甲状腺功能减退（2级irAE）。3例患者的最佳反应均为部分缓解（PR）。截至2020年6月10日的最新随访日期，2例患者仍存活，另1例于2020年1月14日死亡，其无进展生存期（PFS）和总生存期（OS）分别为11个月和16个月。
免疫治疗对于PS较差的重度晚期NSCLC患者仍是一种有效且低毒的选择。可能会出现拉撒路型反应，尤其是在PD-L1强表达（≥50%）的患者中。然而，在此情况下需要更多的真实世界数据或随机临床试验。
