晚期 Merkel 细胞癌的免疫治疗：悉尼西部癌症网络的经验。

Immunotherapy in advanced Merkel cell carcinoma: Sydney west cancer network experience.

机构信息

Department of Surgical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.

Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Camperdown, New South Wales, Australia.

出版信息

J Med Imaging Radiat Oncol. 2021 Oct;65(6):760-767. doi: 10.1111/1754-9485.13243. Epub 2021 May 30.

DOI:10.1111/1754-9485.13243

PMID:34053196

Abstract

INTRODUCTION

Merkel cell carcinoma (MCC) is a highly aggressive skin cancer with no survival benefit demonstrated using palliative cytotoxic chemotherapy in the setting of metastatic MCC. Recently, immune checkpoint inhibitors (anti-PD-L1/PD1) have been approved in this setting after durable clinical response was demonstrated in several clinical trials. In this series, we present a multicentre real-world experience in using anti-PD-L1/PD1 in advanced MCC.

METHODS

A retrospective review was performed of all patients with metastatic MCC who were treated with at least one dose of anti-PD-L1/PD1 presenting to Sydney West Cancer Network (Westmead, Nepean and Blacktown hospitals) was performed between 2016 and 2020. Treatment response was assessed based on morphologic and/or metabolic changes of the disease on FDG-PET/CT scans. Primary end point investigated was objective response rate. Secondary outcomes included therapy toxicity, disease control and overall survival.

RESULTS

Thirteen patients received anti-PD-L1/PD1 with a median age of 82 (range 62-89). Two patients had undergone prior palliative chemotherapy. The median follow-up time was 17 months (range 2-34). The overall, complete and partial response rates were 77% (10), 54% (7) and 23% (3), respectively. Treatment-related grade 1 or 2 toxicity was experienced by 69% with only 2 cases of greater severity. The median progression-free survival and overall survival were 18 months (95% CI 10-26 months) and 33 months (95% CI range 7.6-58.4 months), respectively.

CONCLUSIONS

Consistent with clinical trial results, anti-PD-L1/PD1 therapy in this small series demonstrated efficacy and safety in patients with metastatic MCC.

摘要

简介

默克尔细胞癌（MCC）是一种高度侵袭性的皮肤癌，在转移性 MCC 中，姑息性细胞毒性化疗并未显示生存获益。最近，在几项临床试验中证明了持久的临床反应后，免疫检查点抑制剂（抗 PD-L1/PD1）已在该治疗环境下获得批准。在本系列中，我们介绍了在晚期 MCC 中使用抗 PD-L1/PD1 的多中心真实世界经验。

方法

对 2016 年至 2020 年期间在悉尼西部癌症网络（韦斯特米德、内佩恩和布莱克敦医院）就诊的至少接受过一次抗 PD-L1/PD1 治疗的转移性 MCC 患者进行了回顾性分析。根据 FDG-PET/CT 扫描中疾病的形态和/或代谢变化评估治疗反应。主要研究终点为客观缓解率。次要结局包括治疗毒性、疾病控制和总生存期。

结果

13 例患者接受了抗 PD-L1/PD1 治疗，中位年龄为 82 岁（范围为 62-89 岁）。有 2 例患者曾接受过姑息性化疗。中位随访时间为 17 个月（范围为 2-34 个月）。总缓解率、完全缓解率和部分缓解率分别为 77%（10 例）、54%（7 例）和 23%（3 例）。69%的患者出现 1 或 2 级治疗相关毒性，仅有 2 例毒性较严重。中位无进展生存期和总生存期分别为 18 个月（95%CI 10-26 个月）和 33 个月（95%CI 范围为 7.6-58.4 个月）。