Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre Research Institute, Montreal, QB, Canada; Division of Pulmonary, Critical Care, and Allergy, Department of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Division of Respiratory Medicine, McGill University, Montreal, QB, Canada.
Chest. 2021 Aug;160(2):743-753. doi: 10.1016/j.chest.2021.02.053. Epub 2021 Mar 3.
Programmed death-ligand 1 (PD-L1) testing is feasible in most specimens acquired using endobronchial ultrasound-guided needle aspiration (EBUS-TBNA).
Are the outcomes of patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICI) on the basis of PD-L1 expression in EBUS-TBNA samples significantly different from those of patients who are treated on the basis of PD-L1 expression in histological samples?
Patients treated with pembrolizumab or nivolumab between June 2016 and 2019 were included. Patient characteristics, PD-L1 expression, line of treatment, response (Response Evaluation Criteria in Solid Tumors [RECIST] criteria), and vital status (May 14, 2020) were recorded. Progression-free survival (PFS) and overall survival (OS) were assessed, and hazard ratios (HR) estimated.
A total of 145 patients were treated with pembrolizumab or nivolumab on the basis of PD-L1 expression in EBUS-TBNA (31.7%) or histological (68.3%) samples. Most had metastatic disease, with a predominance of adenocarcinomas (64.1%). First-line pembrolizumab was administered to 61 patients with tumor proportion score ≥50% in EBUS-TBNA (n = 16) or histology samples (n = 45). Median OS and PFS of patients who received first-line pembrolizumab on the basis of PD-L1 results in EBUS-TBNA vs histology samples were not significantly different (OS 25.8 months vs not reached, respectively; HR, 0.82 [95% CI, 0.34-1.95], P = .651). Similarly, the median OS and PFS of patients who received subsequent lines of treatment on the basis of PD-L1 results in EBUS-TBNA vs histological samples were not significantly different (including after adjustment for PD-L1 expression).
These findings suggest that PD-L1 results in EBUS-TBNA samples can guide ICI therapy, with treatment outcomes being comparable to those of patients in whom PD-L1 expression was assessed in histological specimens.
程序性死亡配体 1（PD-L1）检测在使用支气管内超声引导针吸术（EBUS-TBNA）获得的大多数标本中是可行的。
基于 PD-L1 在 EBUS-TBNA 样本中的表达，接受免疫检查点抑制剂（ICI）治疗的晚期非小细胞肺癌（NSCLC）患者的治疗结果是否与基于 PD-L1 在组织学样本中的表达接受治疗的患者有显著不同？
纳入了 2016 年 6 月至 2019 年期间接受 pembrolizumab 或 nivolumab 治疗的患者。记录了患者特征、PD-L1 表达、治疗线数、反应（实体瘤反应评估标准 [RECIST]）和生存状态（2020 年 5 月 14 日）。评估了无进展生存期（PFS）和总生存期（OS），并估计了危险比（HR）。
共有 145 名患者根据 PD-L1 在 EBUS-TBNA（31.7%）或组织学（68.3%）样本中的表达接受 pembrolizumab 或 nivolumab 治疗。大多数患者患有转移性疾病，以腺癌为主（64.1%）。一线 pembrolizumab 用于 61 名患者，其肿瘤比例评分≥50%，EBUS-TBNA（n=16）或组织学样本（n=45）。基于 PD-L1 结果在 EBUS-TBNA 与组织学样本中接受一线 pembrolizumab 治疗的患者的中位 OS 和 PFS 无显著差异（OS 25.8 个月 vs 未达到，分别；HR，0.82 [95% CI，0.34-1.95]，P=0.651）。同样，在 PD-L1 结果的基础上，在 EBUS-TBNA 与组织学样本中接受后续治疗线的患者的中位 OS 和 PFS 无显著差异（包括在调整 PD-L1 表达后）。
这些发现表明，PD-L1 在 EBUS-TBNA 样本中的结果可指导 ICI 治疗，治疗结果与 PD-L1 在组织学标本中评估的患者相当。
