Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
Department of Clinical Research Center, Kobe City Medical Center General Hospital, Kobe, 650-0047, Japan.
Invest New Drugs. 2021 Aug;39(4):1170-1178. doi: 10.1007/s10637-021-01077-7. Epub 2021 Feb 10.
Immune checkpoint inhibitors (ICIs) are effective for previously treated patients with advanced non-small cell lung cancer (NSCLC). However, an unconventional response pattern is sometimes encountered. A dissociated response (DR), characterized by some lesions shrinking and others growing, has been recognized with ICI treatment. In this study, we examined the characteristics and treatment outcomes of DR in previously treated NSCLC patients, receiving nivolumab monotherapy. We conducted a retrospective cohort study of previously treated patients with advanced NSCLC who received nivolumab. We assessed the tumor response of each organ using the Response Evaluation Criteria in Solid Tumors (RECIST) criteria at the first radiologic evaluation. We investigated treatment outcome and compared overall survival using the Kaplan-Meier Method and log-rank tests. Further, we conducted the same analysis in patients who had previously received chemotherapy or tyrosine kinase inhibitor therapy in our hospital. Between April 2016 and September 2018, 107 patients who received nivolumab fulfilled the inclusion criteria. Of them, 5 (5%) patients showed a DR. There were no specific differences in characteristics between DR and non-DR cases. Patients showing DR had significantly longer overall survival than those showing concordant progressive disease (46.9 vs. 8.2 months, p = 0.038). The frequencies of DR in the ICI, chemotherapy, and tyrosine kinase inhibitor-treated cohorts were 5%, 1%, and 4%, respectively. DR was uncommon, but this presented a distinctive pattern of nivolumab response. Some patients might benefit from continuing nivolumab therapy and may achieve a longer overall survival.
免疫检查点抑制剂 (ICI) 对先前接受过治疗的晚期非小细胞肺癌 (NSCLC) 患者有效。然而,有时会遇到一种非常规的反应模式。ICI 治疗时已认识到分离反应 (DR),其特征是一些病灶缩小,而另一些病灶增大。在这项研究中,我们检查了先前接受过治疗的 NSCLC 患者接受纳武利尤单抗单药治疗时 DR 的特征和治疗结果。我们对先前接受过治疗的晚期 NSCLC 患者进行了一项纳武利尤单抗治疗的回顾性队列研究。我们使用实体瘤反应评估标准 (RECIST) 标准评估首次影像学评估时每个器官的肿瘤反应。我们使用 Kaplan-Meier 方法和对数秩检验评估了治疗结果并比较了总生存率。此外,我们在我院先前接受过化疗或酪氨酸激酶抑制剂治疗的患者中进行了相同的分析。2016 年 4 月至 2018 年 9 月,有 107 名接受纳武利尤单抗治疗的患者符合纳入标准。其中,5(5%)例患者出现 DR。DR 和非 DR 病例之间的特征没有明显差异。出现 DR 的患者的总生存率明显长于出现一致进展性疾病的患者(46.9 与 8.2 个月,p = 0.038)。ICI、化疗和酪氨酸激酶抑制剂治疗组中 DR 的频率分别为 5%、1%和 4%。DR 并不常见,但这代表了纳武利尤单抗反应的独特模式。一些患者可能受益于继续纳武利尤单抗治疗,并可能实现更长的总生存率。
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