免疫相关不良事件可预测免疫检查点抑制剂对肺癌患者的疗效：一项荟萃分析

Immune-Related Adverse Events Predict the Efficacy of Immune Checkpoint Inhibitors in Lung Cancer Patients: A Meta-Analysis.

作者信息

Wang Donghui, Chen Cen, Gu Yanli, Lu Wanjun, Zhan Ping, Liu Hongbing, Lv Tangfeng, Song Yong, Zhang Fang

机构信息

Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.

Department of Respiratory and Critical Care Medicine, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.

出版信息

Front Oncol. 2021 Mar 1;11:631949. doi: 10.3389/fonc.2021.631949. eCollection 2021.

BACKGROUND

Immune-related adverse events (irAEs) have been reported to be associated with the efficacy of immunotherapy. Herein, we conducted a meta-analysis to demonstrate that irAEs could predict the efficacy of immune checkpoint inhibitors (ICIs) in lung cancer patients.

METHODS

Literature on the correlation between irAEs and the efficacy of immunotherapy in lung cancer patients were searched to collect the data on objective response rate (ORR), overall survival (OS), or progression-free survival (PFS) of the patients. These data were incorporated into the meta-analysis.

RESULTS

A total of 34 records encompassing 8,115 patients were examined in this study. The irAEs occurrence was significantly associated with higher ORR {risk ratio (RR): 2.43, 95% confidence interval (CI) [2.06-2.88], < 0.00001} and improved OS {hazard ratio (HR): 0.51, 95% CI [0.43-0.61], < 0.00001}, and PFS (HR: 0.50, 95% CI [0.44-0.57], < 0.00001) in lung cancer patients undergoing ICIs. Subgroup analysis revealed that OS was significantly longer in patients who developed dermatological (OS: HR: 0.53, 95%CI [0.42-0.65], < 0.00001), endocrine (OS: HR: 0.55, 95%CI [0.45-0.67], < 0.00001), and gastrointestinal irAEs (OS: HR: 0.58, 95%CI [0.42-0.80], = 0.0009) than in those who did not. However, hepatobiliary, pulmonary, and high-grade (≥3) irAEs were not correlated with increased OS and PFS.

CONCLUSION

The occurrence of irAEs in lung cancer patients, particularly dermatological, endocrine, and gastrointestinal irAEs, is a predictor of enhanced ICIs efficacy.

背景

免疫相关不良事件（irAEs）已被报道与免疫治疗疗效相关。在此，我们进行了一项荟萃分析，以证明irAEs可预测免疫检查点抑制剂（ICIs）在肺癌患者中的疗效。

方法

检索关于肺癌患者irAEs与免疫治疗疗效相关性的文献，收集患者的客观缓解率（ORR）、总生存期（OS）或无进展生存期（PFS）数据，并纳入荟萃分析。

结果

本研究共纳入34项记录，涉及8115例患者。irAEs的发生与更高的ORR显著相关（风险比[RR]：2.43，95%置信区间[CI][2.06 - 2.88]，P < 0.00001），以及改善的OS（风险比[HR]：0.51，95%CI[0.43 - 0.61]，P < 0.00001）和PFS（HR：0.50，95%CI[0.44 - 0.57]，P < 0.00001）在接受ICIs治疗的肺癌患者中。亚组分析显示，发生皮肤（OS：HR：0.53，95%CI[0.42 - 0.65]，P < 0.00001）、内分泌（OS：HR：0.55，95%CI[0.45 - 0.67]，P < 0.00001）和胃肠道irAEs（OS：HR：0.58，95%CI[0.42 - 0.80]，P = 0.0009）的患者的OS显著长于未发生的患者。然而，肝胆、肺部和高级别（≥3级）irAEs与OS和PFS的增加无关。