NOVA National School of Public Health, NOVA University, Lisbon, Portugal.
Skåne University Hospital, Division of Medical and Radiation Oncology, Lund, Sweden.
ESMO Open. 2023 Feb;8(1):100764. doi: 10.1016/j.esmoop.2022.100764. Epub 2023 Jan 12.
Immune checkpoint-inhibitors (ICIs) are changing outcomes in different cancer settings, notably for patients with non-small-cell lung cancer (NSCLC). There are, however, still important gaps of evidence for clinical practice when using these novel treatments. In this study, we assessed physicians' opinion and experience on challenges for clinical practice with ICIs monotherapy in NSCLC.
A survey was conducted on experienced physicians treating patients with NSCLC with ICIs. Two rounds of pilot tests were carried out for validation among a group of experts. Topics under analysis were in relation to treatment of elderly populations, performance status, brain metastases, use of steroids or antibiotics, the effects of gut microbiome, autoimmune diseases, human immunodeficiency virus infection, solid organ transplants, use of anti-programmed cell death protein 1 versus anti-programmed death-ligand 1 drugs, atypical tumour responses, predictors of response, duration of treatment and a final open question on additional relevant challenges.
Two hundred and twenty-one answers were collected, including 106 (48%) valid answers from experts for final analysis (physicians who have treated at least 20 patients with NSCLC with ICIs). The vast majority agreed that the selected topics in this study are important challenges ahead and more evidence is needed. Moreover, predictors of response, treating brain metastasis, shorter duration of treatment, the effects of gut microbiome and concomitant use of steroids were voted the most important topics to be further addressed in prospective clinical research.
This survey contributed to understanding which are the main challenges for clinical practice with ICIs monotherapy in NSCLC. It can also contribute to guide further clinical research, considering the opinions and experience of those who regularly treat NSCLC patients with ICIs.
免疫检查点抑制剂（ICI）正在改变不同癌症治疗领域的结局，尤其是在非小细胞肺癌（NSCLC）患者中。然而，在使用这些新型治疗方法时，临床实践仍存在重要的证据缺口。在这项研究中，我们评估了医生对 NSCLC 患者接受 ICI 单药治疗的临床实践挑战的意见和经验。
对使用 ICI 治疗 NSCLC 的经验丰富的医生进行了一项调查。在一组专家中进行了两轮试点测试以验证该调查。分析的主题与治疗老年人群、表现状态、脑转移、使用类固醇或抗生素、肠道微生物组的影响、自身免疫性疾病、人类免疫缺陷病毒感染、实体器官移植、使用抗程序性细胞死亡蛋白 1 与抗程序性死亡配体 1 药物、非典型肿瘤反应、反应预测因素、治疗持续时间以及关于其他相关挑战的最终开放性问题有关。
共收集了 221 份答卷，其中包括 106 份（48%）来自专家的有效答卷，用于最终分析（至少治疗过 20 例 NSCLC 患者的 ICI 医生）。绝大多数人认为，本研究中选择的主题是未来面临的重要挑战，需要更多的证据。此外，反应预测因素、治疗脑转移、缩短治疗持续时间、肠道微生物组的影响以及同时使用类固醇被选为需要在未来临床研究中进一步解决的最重要主题。
这项调查有助于了解 NSCLC 患者接受 ICI 单药治疗的主要临床实践挑战。考虑到经常使用 ICI 治疗 NSCLC 患者的医生的意见和经验，它也有助于指导进一步的临床研究。
