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免疫相关不良事件发生时间与治疗结局的相关性。

Association between immune-related adverse event timing and treatment outcomes.

机构信息

Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

出版信息

Oncoimmunology. 2022 Jan 5;11(1):2017162. doi: 10.1080/2162402X.2021.2017162. eCollection 2022.

Abstract

The timing of immune-related adverse events (irAE) associated with immune checkpoint inhibitors (ICI) is highly variable. Although the development of irAE has been associated with ICI clinical benefit, how irAE timing influences this association is unknown. We analyzed two independent cohorts including 154 patients with non-small cell lung cancer (NSCLC) treated with PD-1/PD-L1 inhibitors at a single institution (UTSW cohort) and a multi-center cohort of 433 patients with NSCLC who received second-line anti-PD-1/PD-L1 therapy (Global cohort) to assess the association between ICI outcomes and irAE timing. In both cohorts, late-onset irAE occurring more than 3 months after ICI initiation compared to irAE occurring earlier were associated with greater rates of radiographic response (UTSW cohort, 41% versus 28%, = .26; Global cohort, 60% versus 35%, = .02), longer progression-free (UTSW cohort, 13.7 versus 5.6 months, < .01; Global cohort, not reached versus 6.0 months, < .01) and overall survival (UTSW cohort, 30.9 versus 14.6 months, < .01; Global cohort, not reached versus 10.6 months, < .01). Modified landmark analysis at 6 months confirmed an overall survival difference between early- and late-onset irAE. Late-onset irAE was similarly associated with greater response rates and prolonged survival in a cohort of 130 patients with non-NSCLC malignancies, suggesting a conserved association across tumor types. The favorable association between irAE and ICI clinical outcomes may be attributed to later-onset events, which is not wholly explained by survivor bias. These results allude to a distinct biology between early- and late-onset irAE and may guide clinician expectations and thresholds for continuing or modifying immunotherapy.

摘要

免疫相关不良事件(irAE)与免疫检查点抑制剂(ICI)相关的时间高度可变。尽管 irAE 的发展与 ICI 的临床获益相关,但 irAE 时间如何影响这种关联尚不清楚。我们分析了两个独立的队列,包括在一个机构(UTSW 队列)接受 PD-1/PD-L1 抑制剂治疗的 154 例非小细胞肺癌(NSCLC)患者和在多中心队列中接受二线抗 PD-1/PD-L1 治疗的 433 例 NSCLC 患者(全球队列),以评估 ICI 结果与 irAE 时间之间的关联。在两个队列中,与更早发生的 irAE 相比,ICI 开始后 3 个月以上发生的晚期 irAE 与更高的放射学反应率相关(UTSW 队列,41%比 28%, =.26;全球队列,60%比 35%, =.02),更长的无进展生存期(UTSW 队列,13.7 比 5.6 个月, <.01;全球队列,未达到比 6.0 个月, <.01)和总生存期(UTSW 队列,30.9 比 14.6 个月, <.01;全球队列,未达到比 10.6 个月, <.01)。6 个月的改良里程碑分析证实了早期和晚期 irAE 之间的总生存差异。在非 NSCLC 恶性肿瘤的 130 例患者队列中,晚期 irAE 与更高的反应率和延长的生存时间也具有相关性,提示这种关联在肿瘤类型中具有保守性。irAE 与 ICI 临床结局之间的有利关联可能归因于晚期发生的事件,这不能完全用幸存者偏差来解释。这些结果暗示了早期和晚期 irAE 之间存在明显的生物学差异,并可能指导临床医生对继续或修改免疫治疗的期望和阈值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8797/8741287/5727c9a00f57/KONI_A_2017162_F0001_OC.jpg

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