Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Division of Epidemiology, New York University Grossman School of Medicine, New York, NY, USA.
JNCI Cancer Spectr. 2022 Mar 2;6(2). doi: 10.1093/jncics/pkac015.
Although immunotherapy can increase survival in non-small cell lung cancer (NSCLC), response rates are low. It is unclear which characteristics contribute to variability in immunotherapy efficacy and survival. Research is needed to identify reasons for heterogeneity in response rates to better tailor treatments.
Web of Science, Ovid EMBASE, and MEDLINE were queried from 2013 to January 2021, and all studies reporting overall or progression-free survival for patients treated with immunotherapy for NSCLC of at least stage IIIB were screened.
Included were 18 randomized controlled trials (RCTs; 6534 immunotherapy RCTs; 11 192 nonimmunotherapy RCTs) and 16 observational studies (n = 9073 immunotherapy patients). Among RCTs, there was improved survival with the addition of immunotherapy in patients aged younger than 65 years in 10 of 17 studies; smokers in 8 of 15 studies; and males in 10 of 17 studies and 6 of 17 females. Only 5 studies reported outcomes by race. Among observational studies, younger patients (aged younger than 60, younger than 65, or younger than 70 years in most studies) had better survival than older patients (aged 60 years and older, 65 years and older, or 70 years and older) in 4 of 13 studies, ever-smokers in 7 of 13, and females in 2 of 14. Three studies reported race with mixed results.
Although evidence is mixed, younger patients, smokers, and males may derive more benefit from immunotherapy. Evidence on racial differences is limited. Physicians should be mindful of personal characteristics when formulating treatment plans. Further research is needed to understand underlying mechanisms and to identify the best immunotherapy candidates and alternative treatments for those unlikely to benefit.
尽管免疫疗法可以提高非小细胞肺癌（NSCLC）患者的生存率，但应答率较低。目前尚不清楚哪些特征导致了免疫疗法疗效和生存的差异。需要开展研究以确定导致应答率差异的原因，从而更好地进行个体化治疗。
检索了 2013 年至 2021 年 1 月期间的 Web of Science、Ovid EMBASE 和 MEDLINE 数据库，筛选出所有报道免疫疗法治疗至少为 IIIB 期 NSCLC 患者的总生存或无进展生存的研究。
共纳入 18 项随机对照试验（RCT；免疫治疗 RCT 患者 6534 例，非免疫治疗 RCT 患者 11422 例）和 16 项观察性研究（免疫治疗患者 9073 例）。在 RCT 中，有 17 项研究中的 10 项、15 项研究中的 8 项、17 项研究中的 10 项和 17 项研究中的 6 项报告了免疫治疗可改善年龄＜65 岁、吸烟和男性患者的生存。仅有 5 项研究报告了种族相关结局。在观察性研究中，有 13 项研究中的 4 项报告了年龄＜60 岁、年龄＜65 岁或年龄＜70 岁的患者比年龄≥60 岁、年龄≥65 岁或年龄≥70 岁的患者生存获益更好，13 项研究中的 7 项报告了曾经吸烟的患者、14 项研究中的 2 项报告了女性患者生存获益更好。有 3 项研究报告了种族相关数据，但结果不一致。
尽管证据存在差异，但年轻患者、吸烟者和男性可能从免疫治疗中获益更多。关于种族差异的证据有限。医生在制定治疗计划时应考虑个人特征。需要进一步研究以了解潜在机制，并确定最适合免疫治疗的患者以及对获益可能性较小的患者的替代治疗方法。
