Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
Department of Oncology, The People's Hospital of Leling, Leling, China.
J Neurooncol. 2022 Sep;159(3):685-693. doi: 10.1007/s11060-022-04111-7. Epub 2022 Aug 17.
Anti-programmed cell death-ligand 1 (Anti-PD-L1) blockades have become the first-line treatment of extensive-stage small-cell lung cancer (ES-SCLC) from CASPIAN and IMpower133 trials. SCLC has a high incidence of brain metastasis (BM) and brain radiotherapy (BRT) is the main local treatment method, but there is limited data on the BRT-immunotherapy scheme. The aim of the retrospective study is to investigate the clinical efficacy and safety of the first-line anti-PD-L1 blockades combined with BRT in ES-SCLC with BM.
Patients with newly diagnosed ES-SCLC with baseline BMs at Shandong Cancer Hospital and Research Institute between 2017 and 2021 were selected. Patients were divided into the anti-PD-L1+BRT group and BRT group. We also assessed the leukoencephalopathy in both groups.
A total of 46 patients were selected. Fifteen were divided into anti-PD-L1+BRT group and 31 to BRT group. The median overall survival (OS) was not reached (NR) vs 15.9 m (P = 0.172). Progression-free survival (PFS) was numerically prolonged with anti-PD-L1 blockades, but the significance was not reached (median: 9.4 m vs 7.4 m, P = 0.362). The median intracranial PFS was not improved, neither (median: 8.2 m vs 8.9 m, P = 0.620). Objective response rate (ORR) in the two groups was 73.33% vs 77.42% (P = 0.949) and disease control rate (DCR) was both 100%. Intracranial ORR and DCR were 53.33% vs 70.97% (P = 0.239) and 73.33% vs 80.65% (P = 0.855), respectively. There was no significant difference in leukoencephalopathy incidence between the two groups.
The combination of first-line anti-PD-L1 blockades with BRT did not confer a significant survival benefit in ES-SCLC with BM, without enhancing cranial neurotoxicity.
抗程序性死亡配体 1（Anti-PD-L1）阻断剂已成为 CASPIAN 和 IMpower133 试验中广泛期小细胞肺癌（ES-SCLC）的一线治疗方法。SCLC 脑转移发生率高，脑放疗（BRT）是主要的局部治疗方法，但关于 BRT-免疫治疗方案的数据有限。本回顾性研究旨在探讨一线抗 PD-L1 阻断剂联合 BRT 治疗伴脑转移的 ES-SCLC 的临床疗效和安全性。
本研究纳入了 2017 年至 2021 年期间在山东省肿瘤医院和研究所新诊断为 ES-SCLC 且基线存在脑转移的患者。患者被分为抗 PD-L1+BRT 组和 BRT 组。我们还评估了两组患者的脑白质病情况。
共纳入 46 例患者，其中 15 例患者分为抗 PD-L1+BRT 组，31 例患者分为 BRT 组。中位总生存期（OS）未达到（NR）vs15.9m（P=0.172）。尽管使用抗 PD-L1 阻断剂使无进展生存期（PFS）有所延长，但差异无统计学意义（中位：9.4m vs 7.4m，P=0.362）。颅内 PFS 也没有得到改善（中位：8.2m vs 8.9m，P=0.620）。两组患者的客观缓解率（ORR）分别为 73.33%和 77.42%（P=0.949），疾病控制率（DCR）均为 100%。颅内 ORR 和 DCR 分别为 53.33%和 70.97%（P=0.239）和 73.33%和 80.65%（P=0.855），两组间差异无统计学意义。两组间脑白质病的发生率无显著差异。
一线抗 PD-L1 阻断剂联合 BRT 治疗伴脑转移的 ES-SCLC 并未带来显著的生存获益，且未增加颅神经毒性。
