Korphaisarn Krittiya, Danchaivijitr Pongwut, Reungwetwattana Thanyanan, Chewaskulyong Busayamas, Thongthieang Luangyot, Chindaprasirt Jarin, Maneenil Kunlatida, Sathitruangsak Chirawadee, Vinayanuwattikun Chanida
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Front Oncol. 2021 Apr 29;11:572740. doi: 10.3389/fonc.2021.572740. eCollection 2021.
The mainstay systemic treatment for non-oncogenic addictive advanced stage non-small cell lung cancer is chemotherapy. Anti-angiogenic agents are additive compounds that enhance disease control and lead to improvement of overall survival benefit. Recently PD-(L)1 blockage, a checkpoint inhibitor, has been adopted as another line of treatment. A sequential strategy to enhance the efficacy of combination docetaxel and nintedanib after immunotherapy, correlated with genomic mutation, has been explored.
A retrospective cohort study of 56 patients from 8 centers in Thailand who received combination docetaxel and nintedanib the Thai nintedanib Named Patient Use program was conducted. Demographic characteristics, treatment details, and treatment responses were retrieved from medical records.
The majority of patients were male (62.5%) with adenocarcinoma subtype (88%). Thirty-five percent had sensitizing mutation. Combination docetaxel and nintedanib was given as second to fourth line of treatment. Median PFS of docetaxel/nintedanib was 5.6 months [95% CI 4.8-6.9]. Median OS of the entire cohort was 22.5 months [95% CI 20.2-31.1]. Among them, only four patients received this combination after immunotherapy which limited the validity of efficacy analysis. Median PFS of those four patients was 7.9 months [range 5.2-9.1] which was slightly higher than the remaining cohort (median PFS 4.5 months, 95% CI: 4.0-6.0, -value 0.09). Among the adenocarcinoma subtype, a relapse-time of platinum-doublet chemotherapy of more than 6 months was solely indicated as a benefit of combination docetaxel/nintedanib treatment compared to the relapse-time of platinum-doublet chemotherapy of less than 6 months by multivariate HR of PFS 0.32 [95% CI: 0.14-0.68, -value 0.003].
Combination docetaxel and nintedanib provided more benefit in relapse-time of platinum-doublet chemotherapy of more than 6 months in advanced stage adenocarcinoma lung cancer. Neither nor alteration influenced the outcome of treatment.
非致癌性成瘾晚期非小细胞肺癌的主要全身治疗方法是化疗。抗血管生成药物是可增强疾病控制并提高总生存获益的附加化合物。最近，一种检查点抑制剂PD-(L)1阻断剂已被用作另一线治疗方法。人们探索了一种在免疫治疗后增强多西他赛和尼达尼布联合疗效的序贯策略，该策略与基因突变相关。
对泰国8个中心的56例接受多西他赛和尼达尼布联合治疗（泰国尼达尼布指定患者使用项目）的患者进行了一项回顾性队列研究。从医疗记录中获取人口统计学特征、治疗细节和治疗反应。
大多数患者为男性（62.5%），腺癌亚型（88%）。35%有敏感突变。多西他赛和尼达尼布联合治疗作为二线至四线治疗。多西他赛/尼达尼布的中位无进展生存期为5.6个月[95%置信区间4.8-6.9]。整个队列的中位总生存期为22.5个月[95%置信区间20.2-31.1]。其中，只有4例患者在免疫治疗后接受了这种联合治疗，这限制了疗效分析的有效性。这4例患者的中位无进展生存期为7.9个月[范围5.2-9.1]，略高于其余队列（中位无进展生存期4.5个月，95%置信区间：4.0-6.0，P值0.09）。在腺癌亚型中，与铂类双联化疗复发时间少于6个月相比，铂类双联化疗复发时间超过6个月仅被表明是多西他赛/尼达尼布联合治疗的一个益处，多变量无进展生存期风险比为0.32[95%置信区间：0.14-0.68，P值0.003]。
多西他赛和尼达尼布联合治疗在晚期腺癌肺癌铂类双联化疗复发时间超过6个月时提供了更多益处。 改变均未影响治疗结果。
