阳离子两亲性抗组胺药对免疫检查点抑制剂治疗患者结局的影响。
Efficacy of cationic amphiphilic antihistamines on outcomes of patients treated with immune checkpoint inhibitors.
机构信息
Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, MA, USA.
Division of General Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; Division of Hematology and Oncology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
出版信息
Eur J Cancer. 2022 Oct;174:1-9. doi: 10.1016/j.ejca.2022.07.006. Epub 2022 Aug 11.
BACKGROUND
Cationic amphiphilic antihistamines have been shown to improve patient outcomes in immunogenic tumours, but whether they can augment and improve response to immunotherapy is unknown. We aim to evaluate the effect of cationic amphiphilic antihistamines in patients receiving immune checkpoint inhibitors (ICIs).
METHODS
We conducted a retrospective propensity score-matched cohort study at two tertiary referral centres in Taiwan between January 2015 and December 2021. Patients who received desloratadine, cyproheptadine, and ebastine were classified as cationic amphiphilic antihistamine users. The primary outcome was overall survival, and the secondary outcomes were progression-free survival and clinical benefit rate. Patients treated with cationic amphiphilic antihistamines were matched to patients who received non-cationic amphiphilic antihistamines based on variables including age, cancer type, stage, and history of allergic diseases.
RESULTS
A total of 734 ICI-treated patients were included. After matching, 68 cationic amphiphilic antihistamine and non-cationic amphiphilic antihistamine users remained for analysis. Compared with non-cationic amphiphilic antihistamine users, patients who received cationic amphiphilic antihistamines had a significantly longer median overall survival (24.8 versus 10.4 months; Log-rank, p = 0.018) and progression-free survival (10.6 versus 4.93 months; Log-rank, p = 0.004). The use of cationic amphiphilic antihistamines was associated with an approximately 50% lower risk of all-cause mortality (HR, 0.55 [95% CI: 0.34-0.91]). Survival benefits were not seen in patients who received cationic amphiphilic antihistamines before immune checkpoint blockade. These survival benefits were observed regardless of the generation of cationic amphiphilic antihistamines.
CONCLUSION
The use of cationic amphiphilic antihistamines was associated with improved survival among patients treated with immunotherapy.
背景
阳离子两亲性抗组胺药已被证明可改善免疫原性肿瘤患者的预后，但它们是否能增强和改善免疫治疗的反应尚不清楚。我们旨在评估阳离子两亲性抗组胺药在接受免疫检查点抑制剂（ICI）治疗的患者中的作用。
方法
我们在台湾的两家三级转诊中心进行了一项回顾性倾向评分匹配队列研究，时间为 2015 年 1 月至 2021 年 12 月。接受地氯雷他定、赛庚啶和依巴斯汀治疗的患者被归类为阳离子两亲性抗组胺药使用者。主要结局是总生存期，次要结局是无进展生存期和临床获益率。根据年龄、癌症类型、分期和过敏史等变量，将接受阳离子两亲性抗组胺药治疗的患者与接受非阳离子两亲性抗组胺药治疗的患者进行匹配。
结果
共纳入 734 例接受 ICI 治疗的患者。匹配后，68 例阳离子两亲性抗组胺药和非阳离子两亲性抗组胺药使用者仍用于分析。与非阳离子两亲性抗组胺药使用者相比，接受阳离子两亲性抗组胺药的患者中位总生存期（24.8 与 10.4 个月；Log-rank，p=0.018）和无进展生存期（10.6 与 4.93 个月；Log-rank，p=0.004）均显著延长。使用阳离子两亲性抗组胺药与全因死亡率降低约 50%相关（HR，0.55[95%CI：0.34-0.91]）。在接受免疫检查点阻断治疗之前使用阳离子两亲性抗组胺药的患者中未观察到生存获益。这些生存获益与阳离子两亲性抗组胺药的使用时间无关。
结论
在接受免疫治疗的患者中，使用阳离子两亲性抗组胺药与生存改善相关。
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