Department of Medical Oncology, Fujian Medical University Cancer Hospital and Fujian Cancer Hospital, Fuzhou, 350014, Fujian Province, China.
Cancer Bio-Immunotherapy Center, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350014, Fujian Province, China.
Radiat Oncol. 2022 Jul 5;17(1):117. doi: 10.1186/s13014-022-02073-8.
Emerging evidence shows that immune checkpoint inhibitors lead to durable responses in a variety of cancers, including nasopharyngeal carcinoma (NPC), however, combination approaches (i.e., stereotactic body radiation therapy, SBRT) are required to extend this benefit beyond a subset of patients. This study retrospectively evaluated eight recurrent/metastatic NPC patients, to investigate how radiation could potentiate PD-1 checkpoint inhibition therapy.
Between September 2016 and July 2017, eight consecutive cases with histologically confirmed PDL1-positive status, for which prior standard therapy had been ineffective (five patients), were treated at our institution and Macao Clinics and two patients had disease progression within 6 months of completion of definitive chemoradiation, or one patient refused to receive chemoradiotherapy. All received PD-1 inhibitors first, seven of them accepted SBRT with an unmodified PD-1 inhibitors regimen after first evaluation as they were unresponsive to PD-1 inhibitors alone. Treatment was discontinued as long as patients were experiencing a clinical benefit in the opinion of the physicians and at least five cycles were given before stoppage.
Median follow-up time was 56.7 months. The confirmed objective response rate based on RECIST-v1.1 at first evaluation was 12.5% (1/8). For the seven cases who received SBRT, six of them experience an objective response (6/7, 85.7%) after SBRT. Only one patient showed rapid progress and die within 95 days after the initiation of SBRT intervention. Three patients who did not have all lesions exposed to irradiation were available to evaluate the incidence of an abscopal effect, however, it did not occur as expected. Median PFS and OS for the seven patients were 8.0 and 30.8 months after SBRT intervention, respectively. Two-year OS as indicated was 71.0%.
PD-1 inhibitors combined with SBRT demonstrated promising antitumor activity in patients with PD-L1 positive RM-NPC. Patients may benefit from continue immunotherapy beyond disease progression when SBRT was introduced.
新出现的证据表明，免疫检查点抑制剂可在包括鼻咽癌（NPC）在内的多种癌症中产生持久反应，然而，需要联合治疗方法（即立体定向体部放射治疗，SBRT）才能将这种益处扩展到一部分患者之外。本研究回顾性评估了 8 例复发性/转移性 NPC 患者，以研究放射如何增强 PD-1 检查点抑制治疗。
在 2016 年 9 月至 2017 年 7 月期间，我们对 8 例连续的经组织学证实的 PDL1 阳性状态的复发性/转移性 NPC 患者进行了治疗，这些患者之前的标准治疗无效（5 例），他们在我们的机构和澳门诊所接受治疗，有 2 例患者在完成确定性放化疗后 6 个月内疾病进展，或有 1 例患者拒绝接受放化疗。所有患者均首先接受 PD-1 抑制剂治疗，在单独使用 PD-1 抑制剂无效的情况下，7 例患者在首次评估后接受 SBRT 治疗，并保持 PD-1 抑制剂治疗方案不变。只要患者根据医生的意见有临床获益，并且在停药前至少给予了 5 个周期的治疗，就可以停止治疗。
中位随访时间为 56.7 个月。根据 RECIST-v1.1，首次评估的确认客观缓解率为 12.5%（1/8）。对于接受 SBRT 的 7 例患者，在接受 SBRT 后，6 例患者出现客观缓解（6/7，85.7%）。只有 1 例患者在 SBRT 干预开始后 95 天内出现快速进展并死亡。3 例未接受所有病灶照射的患者可评估远隔效应的发生率，但未出现预期的远隔效应。7 例患者接受 SBRT 干预后的中位 PFS 和 OS 分别为 8.0 和 30.8 个月。2 年 OS 为 71.0%。
PD-1 抑制剂联合 SBRT 在 PD-L1 阳性 RM-NPC 患者中显示出有希望的抗肿瘤活性。当引入 SBRT 时，患者可能会在疾病进展后继续从免疫治疗中获益。
