Pons-Tostivint E, Hulo P, Guardiolle V, Bodot L, Rabeau A, Porte M, Hiret S, Demontrond P, Curcio H, Boudoussier A, Veillon R, Mayenga M, Dumenil C, Chatellier T, Gourraud P A, Mazieres J, Bennouna J
Centre Hospitalier Universitaire Nantes, Medical Oncology, Nantes University, 44000, Nantes, France.
Medical Oncology Unit, Clinique Mutualiste de L'Estuaire, Saint-Nazaire, France.
Cancer Immunol Immunother. 2023 Jun;72(6):1881-1890. doi: 10.1007/s00262-022-03359-2. Epub 2023 Jan 24.
Pembrolizumab alone (IO-mono) or in combination with platinum-based chemotherapy (CT-IO) is first-line standard of care for advanced non-small cell lung cancer (NSCLC) patients with PD-L1 ≥ 50%. This retrospective multicentre study assessed real-world use and efficacy of both strategies.
Patients with advanced NSCLC PD-L1 ≥ 50% from eight hospitals who had received at least one cycle of IO-mono or CT-IO were included. Overall survival (OS) and real-word progression-free-survival were estimated using Kaplan-Meier methodology. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs, and a Cox model with inverse propensity treatment weighting was carried out.
Among the 243 patients included, 141 (58%) received IO-mono and 102 (42%) CT-IO. Younger patients, those with symptomatic disease and brain metastases were more likely to be proposed CT-IO. With a median follow-up of 11.5 months (95% CI 10.4-13.3), median OS was not reached, but no difference was observed between groups (p = 0.51). Early deaths at 12 weeks were 11% (95% CI 4.6-16.9) and 15.2% (95% CI 9.0-20.9) in CT-IO and IO groups (p = 0.32). After adjustment for age, gender, performance status, histology, brain metastases, liver metastases and tobacco status, no statistically significant difference was found for OS between groups, neither in the multivariate adjusted model [HR 1.07 (95% CI 0.61-1.86), p = 0.8] nor in propensity adjusted analysis [HR 0.99 (95% CI 0.60-1.65), p = 0.99]. Male gender (HR 2.01, p = 0.01) and PS ≥ 2 (HR 3.28, p < 0.001) were found to be negative independent predictive factors for OS.
Younger patients, those with symptomatic disease and brain metastases were more likely to be proposed CT-IO. However, sparing the chemotherapy in first-line does not appear to impact survival outcomes, even regarding early deaths.
帕博利珠单抗单药治疗（免疫治疗单药）或与铂类化疗联合使用（化疗-免疫治疗）是程序性死亡受体1配体（PD-L1）≥50%的晚期非小细胞肺癌（NSCLC）患者的一线标准治疗方案。这项回顾性多中心研究评估了这两种治疗策略的实际应用情况和疗效。
纳入来自8家医院的PD-L1≥50%的晚期NSCLC患者，这些患者至少接受过1个周期的免疫治疗单药或化疗-免疫治疗。采用Kaplan-Meier方法估计总生存期（OS）和实际无进展生存期。使用Cox比例风险回归模型估计风险比（HRs）和95%置信区间（CIs），并进行了具有逆倾向治疗加权的Cox模型分析。
在纳入的243例患者中，141例（58%）接受免疫治疗单药，102例（42%）接受化疗-免疫治疗。年龄较轻、有症状性疾病和脑转移的患者更有可能接受化疗-免疫治疗。中位随访时间为11.5个月（95%CI 10.4 - 13.3），OS未达到中位生存期，但两组之间未观察到差异（p = 0.51）。化疗-免疫治疗组和免疫治疗组在12周时的早期死亡率分别为11%（95%CI 4.6 - 16.9）和15.2%（95%CI 9.0 - 20.9）（p = 0.32）。在调整年龄、性别、体能状态、组织学类型、脑转移、肝转移和吸烟状况后，两组之间的OS在多变量调整模型中[HR 1.07（95%CI 0.61 - 1.86），p = 0.8]或倾向调整分析中[HR 0.99（95%CI 0.60 - 1.65），p = 0.99]均未发现统计学上的显著差异。男性（HR 2.01，p = 0.01）和体能状态≥2（HR 3.28，p < 0.001）被发现是OS的负性独立预测因素。
年龄较轻、有症状性疾病和脑转移的患者更有可能接受化疗-免疫治疗。然而，一线治疗中不进行化疗似乎不会影响生存结果，即使是关于早期死亡情况。
