Huang Yahan, Wang Jiao, Hu Yanting, Cao Pikun, Wang Gang, Cai Hongchao, Wang Meixiang, Yang Xia, Wei Zhigang, Ye Xin
Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China.
Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
Front Oncol. 2022 Aug 26;12:938827. doi: 10.3389/fonc.2022.938827. eCollection 2022.
Immunotherapy has become widely applied in non-small cell lung cancer (NSCLC) patients. However, the relatively low response rate of immunotherapy monotherapy restricts its application. Combination therapy improves the response rate and prolongs patient survival; however, adverse events (AEs) associated with immunotherapies increase with combination therapy. Therefore, exploring combination regimens with equal efficacy and fewer AEs is urgently required. The aim of this study was to evaluate the efficacy and safety of microwave ablation (MWA) plus camrelizumab monotherapy or combination therapy in NSCLC.
Patients with pathologically confirmed, epidermal growth factor receptor/anaplastic lymphoma kinase-wild-type NSCLC were retrospectively enrolled in this study. Patients underwent MWA to the pulmonary lesions first, followed by camrelizumab monotherapy or combination therapy 5-7 days later. Camrelizumab was administered with the dose of 200 mg every 2 to 3 weeks. Treatment was continued until disease progression or intolerable toxicities. The technical success and technique efficacy of ablation, objective response rate (ORR), progression-free survival (PFS), overall survival (OS), complications of ablation, and AEs were recorded.
From January 1, 2019 to December 31, 2021, a total of 77 patients underwent MWA and camrelizumab monotherapy or combination therapy. Technical success was achieved in all patients (100%), and the technique efficacy was 97.4%. The ORR was 29.9%. The PFS and OS were 11.8 months (95% confidence interval, 9.5-14.1) and not reached, respectively. Smoking history and response to camrelizumab were correlated with PFS, and response to camrelizumab was correlated with OS in both the univariate and multivariate analyses. No periprocedural deaths due to ablation were observed. Complications were observed in 33 patients (42.9%). Major complications included pneumothorax (18.2%), pleural effusion (11.7%), pneumonia (5.2%), bronchopleural fistula (2.6%), and hemoptysis (1.3%). Grade 3 or higher AEs of camrelizumab, including reactive capillary endothelial proliferation, fatigue, pneumonia, edema, and fever, were observed in 10.4%, 6.5%, 5.2%, 2.6%, and 2.6% of patients, respectively.
MWA combined with camrelizumab monotherapy or combination therapy is effective and safe for the treatment of NSCLC.
免疫疗法已广泛应用于非小细胞肺癌（NSCLC）患者。然而，免疫疗法单药治疗的缓解率相对较低，限制了其应用。联合治疗可提高缓解率并延长患者生存期；然而，与免疫疗法相关的不良事件（AE）会随着联合治疗而增加。因此，迫切需要探索疗效相当且不良事件较少的联合治疗方案。本研究的目的是评估微波消融（MWA）联合卡瑞利珠单抗单药治疗或联合治疗在NSCLC中的疗效和安全性。
本研究回顾性纳入了经病理确诊的表皮生长因子受体/间变性淋巴瘤激酶野生型NSCLC患者。患者首先对肺部病变进行MWA，然后在5-7天后接受卡瑞利珠单抗单药治疗或联合治疗。卡瑞利珠单抗每2至3周给药一次，剂量为200mg。持续治疗直至疾病进展或出现无法耐受的毒性反应。记录消融的技术成功率和技术疗效、客观缓解率（ORR）、无进展生存期（PFS）、总生存期（OS）、消融并发症和AE。
2019年1月1日至2021年12月31日，共有77例患者接受了MWA和卡瑞利珠单抗单药治疗或联合治疗。所有患者均取得技术成功（100%），技术疗效为97.4%。ORR为29.9%。PFS和OS分别为11.8个月（95%置信区间，9.5-14.1）和未达到。在单因素和多因素分析中，吸烟史和对卡瑞利珠单抗的反应与PFS相关，对卡瑞利珠单抗的反应与OS相关。未观察到因消融导致的围手术期死亡。33例患者（42.9%）出现并发症。主要并发症包括气胸（18.2%）、胸腔积液（11.7%）、肺炎（5.2%）、支气管胸膜瘘（2.6%）和咯血（1.3%）。分别有10.4%、6.5%、5.2%、2.6%和2.6%的患者出现卡瑞利珠单抗3级或更高等级的AE，包括反应性毛细血管内皮增生、疲劳、肺炎、水肿和发热。
MWA联合卡瑞利珠单抗单药治疗或联合治疗对NSCLC的治疗有效且安全。
