Department of Hematology and Oncology, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan.
Department of Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-Cho Kita-Ku Okayama City, Okayama, 700-8558, Japan.
J Cancer Res Clin Oncol. 2023 Jul;149(8):4933-4938. doi: 10.1007/s00432-022-04415-1. Epub 2022 Oct 29.
Combination therapy with immune checkpoint inhibitors (ICIs) and chemotherapy (ICI + chemotherapy) has become the standard first line treatment for driver oncogene-negative advanced non-small-cell lung cancer (NSCLC). However, it may be more toxic compared to monotherapy, which limits its use. Moreover, the feasibility of the combination therapy in clinical practice remains unknown.
We conducted a cohort study to determine the implementation rate of ICI + chemotherapy in clinical practice. We retrospectively reviewed clinical data from advanced NSCLC patients who received systemic therapy at 13 institutions between December 2018 and December 2020.
After excluding 154 patients with epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) gene alterations, a total of 919 NSCLC patients were included. Among them, 442 were treated with ICI + chemotherapy (48%), whereas 477 were treated with other therapies (52%). Among these 477 patients, 340 did not receive ICI + chemotherapy because of intolerance (71%); thus, more than one-third of the advanced NSCLC patients do not benefit from the combination therapy due to intolerance. Among the 659 NSCLC patients for whom PD-L1 was < 50% or unknown, only 342 received the ICI + chemotherapy combination (52%) even though it is considered preferable to either therapy alone; the remaining 318 patients were treated with other therapies (48%). Among the 318 patients who did not receive ICI + chemotherapy, 274 were intolerant to it (86%).
Our results revealed that a substantial proportion of advanced NSCLC patients did not benefit from ICI + chemotherapy due to intolerance. As treatments for NSCLC are moving toward combinations for greater efficacy, their feasibility in clinical practice must be taken into consideration.
免疫检查点抑制剂（ICI）联合化疗（ICI+化疗）已成为驱动基因阴性晚期非小细胞肺癌（NSCLC）的标准一线治疗方法。然而，与单药治疗相比，它可能毒性更大，从而限制了其应用。此外，联合治疗在临床实践中的可行性仍不清楚。
我们进行了一项队列研究，以确定 ICI+化疗在临床实践中的实施率。我们回顾性分析了 2018 年 12 月至 2020 年 12 月期间 13 家机构接受系统治疗的晚期 NSCLC 患者的临床数据。
排除表皮生长因子受体（EGFR）或间变性淋巴瘤激酶（ALK）基因改变的 154 例患者后，共纳入 919 例 NSCLC 患者。其中，442 例接受 ICI+化疗（48%），477 例接受其他治疗（52%）。在这 477 例患者中，340 例因不耐受（71%）未接受 ICI+化疗，因此，超过三分之一的晚期 NSCLC 患者因不耐受而无法从联合治疗中获益。在 659 例 PD-L1<50%或未知的 NSCLC 患者中，仅 342 例接受了 ICI+化疗联合治疗（52%），即使它被认为优于单独治疗；其余 318 例接受了其他治疗（48%）。在未接受 ICI+化疗的 318 例患者中，274 例对其不耐受（86%）。
我们的研究结果表明，相当一部分晚期 NSCLC 患者因不耐受而无法从 ICI+化疗中获益。随着 NSCLC 治疗方法向联合治疗以提高疗效的方向发展，必须考虑其在临床实践中的可行性。
