Department of Respiratory Medicine, Rakuwakai Otowa Hospital, 2 Otowachinji-cho, Yamashina, Kyoto, 607-8062, Japan.
Department of Medical Oncology, Rakuwakai Otowa Hospital, Kyoto, Japan.
J Cancer Res Clin Oncol. 2023 Jun;149(6):2475-2482. doi: 10.1007/s00432-022-04125-8. Epub 2022 Jun 23.
The effect of immuno-chemotherapy on patients with advanced non-small-cell lung cancer (NSCLC) harboring oncogenic mutations remains poorly understood. This study aimed to characterize the efficacy of immuno-chemotherapy and determine the optimal treatment strategy for such patients.
We conducted this retrospective cohort study on patients with NSCLC harboring oncogenic driver alterations and treated with an immune checkpoint inhibitor combined with chemotherapy at five institutions. The clinical characteristics and outcomes of immuno-chemotherapy for NSCLC with oncogenic mutations in a real-world setting were analyzed.
Among 846 patients diagnosed with advanced or recurrent NSCLC between April 2017 and April 2021, 43 patients with oncogenic mutations were treated with immuno-chemotherapy. The median age of patients was 68 (range 44-78) years; 42% of patients never smoked, and adenocarcinoma was the most common histology (95%). In patients with KRAS mutations (n = 10) or PD-L1 expression of 50% or greater (n = 10), the disease control rate was 100%. The median progression-free survival (PFS) was 5.4, 6.3, and 8.9 months in patients harboring mutations in EGFR, KRAS, and other genes, respectively (P = 0.22). Patients with PD-L1 expression of 50% or greater had significantly longer median PFS than patients with PD-L1 expression of less than 50% (16.4 vs. 5.1 months; P = 0.001). Two patients experienced grade 3 immuno-related adverse events.
Immuno-chemotherapy has a clinical benefit and is safe for patients with oncogenic mutations. Notably, patients with PD-L1 expression of 50% or more experience greater benefit from immuno-chemotherapy than those with PD-L1 expression of less than 50%.
免疫化疗对携带致癌突变的晚期非小细胞肺癌（NSCLC）患者的疗效仍知之甚少。本研究旨在描述免疫化疗的疗效，并确定此类患者的最佳治疗策略。
我们在五家机构对接受免疫检查点抑制剂联合化疗治疗的携带致癌驱动改变的 NSCLC 患者进行了这项回顾性队列研究。分析了真实世界中具有致癌突变的 NSCLC 患者接受免疫化疗的临床特征和结局。
在 2017 年 4 月至 2021 年 4 月期间诊断为晚期或复发性 NSCLC 的 846 例患者中，有 43 例患者携带致癌突变接受了免疫化疗。患者的中位年龄为 68（44-78）岁；42%的患者从不吸烟，腺癌是最常见的组织学类型（95%）。在携带 KRAS 突变（n=10）或 PD-L1 表达 50%或更高（n=10）的患者中，疾病控制率为 100%。分别携带 EGFR、KRAS 和其他基因突变的患者中位无进展生存期（PFS）为 5.4、6.3 和 8.9 个月（P=0.22）。PD-L1 表达 50%或更高的患者中位 PFS 明显长于 PD-L1 表达低于 50%的患者（16.4 与 5.1 个月；P=0.001）。有 2 例患者发生 3 级免疫相关不良事件。
免疫化疗对携带致癌突变的患者具有临床获益且安全。值得注意的是，PD-L1 表达 50%或更高的患者从免疫化疗中获益大于 PD-L1 表达低于 50%的患者。
