Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, China.
Department of Surgery, Yuyao Maternity and Child Health Care Hospital, Ningbo, China.
Lipids Health Dis. 2021 Nov 20;20(1):165. doi: 10.1186/s12944-021-01596-5.
Anlotinib, a small molecule for multi-target tyrosine kinase inhibition, is the third or further line of defense for treatment of non-small cell lung cancer (NSCLC). Findings from an ALTER0303 phase III trial revealed that this drug confers significant survival benefits in patients. Although numerous inflammatory biomarkers have been shown to play vital roles in treatment, the clinical significance of blood lipid levels before treatment has not been evaluated. Here, this research aims to explore the relationship between blood lipids and efficacy of anlotinib, with a view of generating insights to guide future development of convenient and individualized treatment therapies.
This study analyzed basal blood lipids levels, including triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL), and high density lipoprotein (HDL), among other variables before treatment, in 137 patients with advanced NSCLC who received anlotinib as third or further-line treatment at the Ningbo Medical Center Lihuili Hospital, between July 2018 and December 2020. We determined the best cut off value for predicting treatment responses, generated survival curves using the Kaplan-Meier method, then applied univariate and multivariate Cox regression analyses to assess predictors of survival.
The entire study population recorded median progression-free survival (PFS) and overall survival (OS) of 4 (95% CI 3.142-4.858) and 8.3 (95% CI 6.843-9.757) months, respectively. Researchers observed statistically significant differences across subgroups, between blood lipid indexes with different efficacies, except in the HDL subgroup. The low disease control rate (DCR) was associated with significantly elevated TG, TC and LDL levels (P = 0.000). Multivariate analysis demonstrated that elevated TC and LDL levels were independently associated with poor PFS or OS (P ≤ 0.003). Then, we established a prediction model, and set high TC or high LDL as the risk factor, respectively. There were significant differences in PFS (p = 0.000) and OS (p = 0.012) between 0 and ≥ 1 scores.
Prior to anlotinib therapy, TC and LDL levels, are independent prognostic indicators for patients with advanced NSCLC treated with this drug as a third or further-line treatment option. In addition, a risk score of 0 was attributed to a combination of low TC and low LDL, and these patients were exhibited excellent efficacies and survival rates.
安罗替尼是一种用于多靶点酪氨酸激酶抑制的小分子药物，是治疗非小细胞肺癌（NSCLC）的三线或三线以上治疗药物。ALTER0303 三期临床试验结果表明，该药物可显著改善患者的生存获益。虽然许多炎症生物标志物已被证明在治疗中起着至关重要的作用，但治疗前血脂水平的临床意义尚未得到评估。本研究旨在探讨安罗替尼治疗前血脂水平与疗效的关系，以期为指导未来开发方便、个体化的治疗方案提供思路。
本研究分析了 2018 年 7 月至 2020 年 12 月在宁波市医疗中心李惠利医院接受安罗替尼三线或三线以上治疗的 137 例晚期 NSCLC 患者的治疗前基础血脂水平，包括甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）等其他变量。我们确定了预测治疗反应的最佳截断值，使用 Kaplan-Meier 方法生成生存曲线，然后应用单变量和多变量 Cox 回归分析评估生存的预测因素。
整个研究人群的中位无进展生存期（PFS）和总生存期（OS）分别为 4 个月（95%CI 3.142-4.858）和 8.3 个月（95%CI 6.843-9.757）。研究人员观察到不同疗效亚组之间的血脂指标存在统计学差异，除了 HDL 亚组外。低疾病控制率（DCR）与 TG、TC 和 LDL 水平显著升高相关（P=0.000）。多变量分析表明，TC 和 LDL 水平升高与 PFS 或 OS 不良独立相关（P≤0.003）。然后，我们建立了一个预测模型，将高 TC 或高 LDL 作为风险因素。在 PFS（p=0.000）和 OS（p=0.012）方面，0 分和≥1 分之间存在显著差异。
在接受安罗替尼治疗前，TC 和 LDL 水平是接受该药物三线或三线以上治疗的晚期 NSCLC 患者的独立预后指标。此外，风险评分为 0 分表示 TC 和 LDL 均较低，这些患者具有出色的疗效和生存率。
