肿瘤负担对 PD-1/PD-L1 抑制剂联合化疗治疗非小细胞肺癌疗效的临床影响。

Clinical impact of tumour burden on the efficacy of PD-1/PD-L1 inhibitors plus chemotherapy in non-small-cell lung cancer.

机构信息

Division of Thoracic Oncology, Shizuoka Cancer Centre, Shizuoka, Japan.

Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.

出版信息

Cancer Med. 2023 Jan;12(2):1451-1460. doi: 10.1002/cam4.5035. Epub 2022 Jul 18.

BACKGROUND

Programmed cell death 1 (PD-1)/programmed cell death ligand (PD-L1) inhibitors plus chemotherapy (ICI + Chemo) is the standard treatment for advanced non-small-cell lung cancer (NSCLC). However, the impact of tumour burden on the efficacy of ICI + Chemo remains unknown.

METHODS

We retrospectively evaluated 92 patients with advanced NSCLC treated with ICI + Chemo. Tumour burden was assessed as the sum of the longest diameter of the target lesion (BSLD) and number of metastatic lesions (BNMLs). We categorised the patients into three groups based on the combined BSLD and BNML values.

RESULTS

Sixty-eight patients (74%) had progressive disease or died. Forty-four patients (48%) in the low-BSLD group had a median progression-free survival (PFS) of 9.5 months, whereas patients in the high-BSLD group had a median PFS of 4.6 months (hazard ratio [HR] = 0.54, p = 0012). Twenty-five patients (27%) in the low-BNML group had a median PFS of 9.6 months, whereas patients in the high-BNML group had a median PFS of 6.5 months (HR = 0.51, p = 0.029). Low-BSLD and low-BNML were associated independently with improved PFS in multivariate analysis. Analysis of the tumour burden combined with BSLD and BNML revealed a trend towards improved PFS as the tumour burden decreased, with median PFS of 22.3, 8.7, and 3.9 months in the low- (N = 13), medium- (N = 42) and high-burden (N = 37) groups respectively.

CONCLUSIONS

Our findings demonstrated that a high tumour burden negatively impacts the efficacy of ICI + Chemo in patients with advanced NSCLC.

背景

程序性细胞死亡受体 1（PD-1）/程序性细胞死亡配体 1（PD-L1）抑制剂联合化疗（ICI+Chemo）是晚期非小细胞肺癌（NSCLC）的标准治疗方法。然而，肿瘤负担对 ICI+Chemo 疗效的影响尚不清楚。

方法

我们回顾性评估了 92 例接受 ICI+Chemo 治疗的晚期 NSCLC 患者。肿瘤负担评估为靶病变最长直径（BSLD）和转移病变数（BNML）的总和。我们根据联合 BSLD 和 BNML 值将患者分为三组。

结果

68 例（74%）患者出现疾病进展或死亡。低 BSLD 组 44 例（48%）患者的中位无进展生存期（PFS）为 9.5 个月，而高 BSLD 组患者的中位 PFS 为 4.6 个月（风险比[HR] = 0.54，p = 0.012）。低 BNML 组 25 例（27%）患者的中位 PFS 为 9.6 个月，而高 BNML 组患者的中位 PFS 为 6.5 个月（HR = 0.51，p = 0.029）。多变量分析显示，低 BSLD 和低 BNML 与 PFS 改善独立相关。肿瘤负担联合 BSLD 和 BNML 分析显示，随着肿瘤负担的降低，PFS 有改善的趋势，低（N=13）、中（N=42）和高（N=37）三组患者的中位 PFS 分别为 22.3、8.7 和 3.9 个月。