Department of Medical Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No.1 Banshan East Street, Gongshu District, Hangzhou, Zhejiang, 310022, People's Republic of China.
Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou Zhejiang, 310022, China.
Cancer Immunol Immunother. 2022 Jul;71(7):1693-1703. doi: 10.1007/s00262-021-03115-y. Epub 2021 Nov 24.
Patients treated with immune checkpoint inhibitors (ICIs) often experience unique immune-related adverse events (irAEs), and the previous studies demonstrated an association between irAEs and better outcomes in patients with ICI treatment for advanced non-small cell lung cancer (NSCLC). However, the correlation between the occurrence of mild and severe irAEs and prognosis remains unclear. Additionally, little is known regarding the association between the timing of mild and severe irAEs and clinical outcomes. We retrospectively conducted a multicenter study of advanced NSCLC patients treated with ICI monotherapy. Of the 222 patients, 79 patients (35.6%) experienced at least one irAE, and most were of grade 1 or 2 (mild) (26.6%). The most common irAEs were pneumonitis (n = 21, 9.5%) and skin-related adverse reactions (n = 19, 8.6%). The median progression-free survival of all patients treated with ICIs was 3.2 months. Patients experiencing irAEs had a better prognosis than those without such events (6.5 vs. 2.6 months, p = 0.004), and mild irAEs were associated with the best prognosis. The difference in overall survival between mild and severe irAEs was significant (34.3 vs. 17.3 months, p = 0.021). We further analyzed differences between patients with irAEs occurring at 3 or 6 weeks, and found that the earlier the occurrence of mild irAEs, the better the prognosis; however, the opposite was true for severe irAEs. In summary, patients with early occurring mild irAEs showed better clinical outcomes, whereas those with early severe irAEs tended to show poorer clinical outcomes.
接受免疫检查点抑制剂 (ICI) 治疗的患者常出现独特的免疫相关不良反应 (irAE)，既往研究表明，irAE 与接受 ICI 治疗晚期非小细胞肺癌 (NSCLC) 患者的更好结局相关。然而，轻度和重度 irAE 的发生与预后之间的相关性尚不清楚。此外，关于轻度和重度 irAE 的发生时间与临床结局之间的关联，人们知之甚少。我们回顾性地对接受 ICI 单药治疗的晚期 NSCLC 患者进行了多中心研究。在 222 例患者中，79 例 (35.6%) 至少发生了一次 irAE，且大多数为 1 级或 2 级 (轻度) (26.6%)。最常见的 irAE 是肺炎 (n = 21，9.5%) 和皮肤相关不良反应 (n = 19，8.6%)。所有接受 ICI 治疗的患者的中位无进展生存期为 3.2 个月。发生 irAE 的患者比未发生此类事件的患者预后更好 (6.5 个月 vs. 2.6 个月，p = 0.004)，且轻度 irAE 与最佳预后相关。轻度和重度 irAE 之间的总生存期差异具有统计学意义 (34.3 个月 vs. 17.3 个月，p = 0.021)。我们进一步分析了发生在 3 周或 6 周时的 irAE 患者之间的差异，发现轻度 irAE 发生越早，预后越好；然而，重度 irAE 则相反。总之，早期发生轻度 irAE 的患者表现出更好的临床结局，而早期发生重度 irAE 的患者则倾向于表现出更差的临床结局。
