Department of Radiation Oncology, Centre Antoine-Lacassagne, University Côte d'Azur, Fédération Claude Lalanne, Nice, France.
Department of Radiation Oncology, Centre Antoine-Lacassagne, University Côte d'Azur, Fédération Claude Lalanne, Nice, France; Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong, PR China.
Cancer Radiother. 2022 Nov;26(8):1045-1053. doi: 10.1016/j.canrad.2022.04.005. Epub 2022 Aug 1.
Preclinical and clinical data suggest a potential benefit in the addition of radiotherapy (RT) to immune-checkpoint inhibitors (ICI) during the treatment of advanced cancers. Nevertheless, the ideal patients for this approach and the optimal RT regimen is still debated.
The aim of this study was to determine the effect RT schedule has on survival for advanced non-small cell lung cancer and melanoma patients (pts) treated with ICI (anti-PD1 or anti-CTLA4) and concomitant RT.
A total of 58 pts were identified, of which 26 received RT concomitantly with ICI while the remaining 32 pts were treated with RT at the time of progression under ICI. The RT parameters associated with outcome include dose per fraction, biological effective dose, RT to all targets and lung irradiation. Independent predictors of improved progression-free survival were lung irradiation, melanoma histology, oligometastatic status (<6 metastasis), presence of liver metastasis, PNN<7000/mm and normal LDH. Independent predictors of improved overall survival were melanoma histology and normal LDH. Among pts who were irradiated at progression, 68.7% had an overall clinical benefit and had a median extension of ICI use by 2.3 months (range: 0-29.1), among which 2 presented with an abscopal effect.
The irradiation of lung metastases may increase survival in patients under ICI. RT at progression could prolong the use of ICI, and neutrophilia and LDH should be considered during patient selection of this combined RT/ICI approach.
临床前和临床数据表明，在治疗晚期癌症时，将放射治疗（RT）与免疫检查点抑制剂（ICI）联合使用可能会带来益处。然而，这种方法的理想患者以及最佳 RT 方案仍存在争议。
本研究旨在确定 RT 方案对接受 ICI（抗 PD-1 或抗 CTLA-4）联合 RT 治疗的晚期非小细胞肺癌和黑色素瘤患者（pts）的生存影响。
共确定了 58 例 pts，其中 26 例在接受 ICI 的同时接受 RT，而其余 32 例在接受 ICI 治疗时进展时接受 RT。与结局相关的 RT 参数包括单次剂量、生物有效剂量、所有靶区的 RT 和肺照射。无进展生存期改善的独立预测因素包括肺照射、黑色素瘤组织学、寡转移状态（<6 个转移）、肝转移存在、PNN<7000/mm 和正常 LDH。总生存期改善的独立预测因素包括黑色素瘤组织学和正常 LDH。在进展时接受放疗的 pts 中，68.7%的患者具有总体临床获益，并且 ICI 治疗的中位延长时间为 2.3 个月（范围：0-29.1），其中 2 例出现了远隔效应。
对 ICI 下的患者的肺转移灶进行照射可能会提高其生存率。进展时的 RT 可能会延长 ICI 的使用时间，在选择这种联合 RT/ICI 方法时，应考虑中性粒细胞增多和 LDH。
