Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Medical Oncology, University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands.
Anticancer Res. 2022 Oct;42(10):4795-4804. doi: 10.21873/anticanres.15984.
BACKGROUND/AIM: Recent studies described the safety and clinical utility of combined anti-programmed cell death protein-1 (anti-PD1) checkpoint inhibition with radiotherapy. However, long-term follow-up data are lacking. Abscopal effects have been hypothesized, though clinical proof is still scarce.
We analyzed the efficacy and toxicity of combined (stereotactic) radiotherapy and anti-PD1 in consecutive oligoprogressive melanoma and non-small cell lung cancer (NSCLC) patients who were irradiated for 1 to 3 progressive metastases during anti-PD-1 in our institute between January 2017 and January 2019 and verified one-dimensional RECIST measurements by volumetric assessments.
Out of 361 patients, 11 melanoma and 5 NSCLC patients were included in this series. Radiotherapy was applied after a median of 11 months (range=1-30 months) from the start of anti-PD1 treatment. No increased risk of adverse events for the combined treatments was observed. With a median follow-up of 4.9 years since the start of anti-PD1, 69% of patients were alive. Six of 16 patients had stable disease after a median follow-up of 4.1 years after radiotherapy. Abscopal effects were suspected in three out of 16 patients. However, if volumetric assessment was used, two of these patients already had tumor shrinkage prior to radiotherapy, not detected by one-dimensional measurements.
Stereotactic radiotherapy for oligoprogressive disease during PD1-inhibition can induce long-term disease control. Although abscopal effects were suspected in three patients, they were not confirmed with volumetric assessment in two patients. The discrepancy found between one-dimensional and volumetric response assessment argues for including volumetric assessment in further studies.
背景/目的：最近的研究描述了联合抗程序性细胞死亡蛋白 1（抗 PD-1）检查点抑制与放射治疗的安全性和临床实用性。然而，缺乏长期随访数据。虽然已经假设了远隔效应，但临床证据仍然很少。
我们分析了我院 2017 年 1 月至 2019 年 1 月期间，连续患有寡发性进展性黑色素瘤和非小细胞肺癌（NSCLC）的患者在接受抗 PD-1 治疗期间对 1 至 3 个进展性转移灶进行（立体定向）放射治疗和抗 PD-1 联合治疗的疗效和毒性，并用容积评估验证了一维 RECIST 测量。
在 361 名患者中，11 名黑色素瘤和 5 名 NSCLC 患者纳入了本系列。放射治疗是在开始抗 PD1 治疗后 11 个月（范围为 1-30 个月）中位数时应用的。联合治疗未观察到不良事件风险增加。自开始抗 PD1 以来，中位随访时间为 4.9 年，69%的患者存活。放射治疗后中位随访 4.1 年后，16 名患者中有 6 名稳定疾病。在 16 名患者中，有 3 名怀疑发生了远隔效应。然而，如果使用容积评估，其中 2 名患者在放射治疗前已经有肿瘤缩小，而一维测量则未检测到。
PD1 抑制期间寡发性进展性疾病的立体定向放射治疗可以诱导长期疾病控制。尽管在 3 名患者中怀疑发生了远隔效应，但在 2 名患者中，通过容积评估并未得到证实。一维和容积反应评估之间发现的差异表明，在进一步的研究中应包括容积评估。
