转移性非小细胞肺癌免疫治疗失败后基于不同寡进展模式的治疗策略
Treatment strategies based on different oligoprogressive patterns after immunotherapy failure in metastatic NSCLC.
作者信息
Xuzhang Wendi, Huang Huayan, Yu Yongfeng, Shen Lan, Li Ziming, Lu Shun
机构信息
Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, West Huaihai Road 241, Shanghai 200030, China.
出版信息
Ther Adv Med Oncol. 2023 Mar 4;15:17588359231156387. doi: 10.1177/17588359231156387. eCollection 2023.
BACKGROUND
Oligoprogressive disease is recognized as the overall umbrella term; however, a small number of progressions on imaging can represent different clinical scenarios. This study aims to explore the optimal treatment strategy after immunotherapy (IO) resistance in advanced non-small-cell lung cancer (NSCLC), especially in personalized therapies for patients with different oligoprogressive patterns.
METHODS
Based on European Society for Radiotherapy and Oncology/European Organization for Research and Treatment of Cancer consensus, metastatic NSCLC patients with cancer progression after IO resistance were divided into four patterns, repeat oligoprogression (REO, oligoprogression with a history of oligometastatic disease), induced oligoprogression (INO, oligoprogression with a history of polymetastatic disease), de-novo polyprogression (DNP, polyprogression with a history of oligometastatic disease), and repeat polyprogression (REP, polyprogression with a history of polymetastatic disease). Patients with advanced NSCLC who received programmed cell death-1/programmed cell death ligand-1 inhibitors between January 2016 and July 2021 at Shanghai Chest Hospital were identified. The progression patterns and next-line progression-free survival (nPFS), overall survival (OS) were investigated stratified by treatment strategies. nPFS and OS were calculated using the Kaplan-Meier method.
RESULTS
A total of 500 metastatic NSCLC patients were included. Among 401 patients developed progression, 36.2% (145/401) developed oligoprogression and 63.8% (256/401) developed polyprogression. Specifically, 26.9% (108/401) patients had REO, 9.2% (37/401) patients had INO, 27.4% (110/401) patients had DNP, and 36.4% (146/401) patients had REP, respectively. The patients with REO who received local ablative therapy (LAT) had significant longer median nPFS and OS compared with no LAT group (6.8 3.3 months; = 0.0135; OS, not reached 24.5 months; = 0.0337). By contrast, there were no nPFS and OS differences in INO patients who received LAT compared with no LAT group (nPFS, 3.6 5.3 months; = 0.3540; OS, 36.6 45.4 months; = 0.8659). But in INO patients, there were significant longer median nPFS and OS using IO maintenance by contrast with IO halt treatment (nPFS, 6.1 4.1 months; = 0.0264; OS, 45.4 32.3 months; = 0.0348).
CONCLUSIONS
LAT (radiation or surgery) is more important for patients with REO while IO maintenance plays a more dominant role in patients with INO.
背景
寡进展性疾病被认为是一个总体术语；然而，影像学上的少数进展可能代表不同的临床情况。本研究旨在探讨晚期非小细胞肺癌（NSCLC）免疫治疗（IO）耐药后的最佳治疗策略，尤其是针对不同寡进展模式患者的个性化治疗。
方法
根据欧洲放射肿瘤学会/欧洲癌症研究与治疗组织的共识，将IO耐药后出现癌症进展的转移性NSCLC患者分为四种模式，即重复寡进展（REO，有寡转移病史的寡进展）、诱导寡进展（INO，有多转移病史的寡进展）、新发多进展（DNP，有寡转移病史的多进展）和重复多进展（REP，有多转移病史的多进展）。确定2016年1月至2021年7月在上海胸科医院接受程序性细胞死亡蛋白1/程序性细胞死亡配体1抑制剂治疗的晚期NSCLC患者。按治疗策略分层研究进展模式及二线无进展生存期（nPFS）、总生存期（OS）。nPFS和OS采用Kaplan-Meier法计算。
结果
共纳入500例转移性NSCLC患者。在401例出现进展的患者中，36.2%（145/401）出现寡进展，63.8%（256/401）出现多进展。具体而言，分别有26.9%（108/401）的患者为REO，9.2%（37/4）的患者为INO，27.4%（110/401）的患者为DNP，36.4%（146/401）的患者为REP。接受局部消融治疗（LAT）的REO患者的中位nPFS和OS显著长于未接受LAT组（6.8对3.3个月；P = 0.0135；OS，未达到对24.5个月；P = 0.0337）。相比之下，接受LAT的INO患者与未接受LAT组的nPFS和OS无差异（nPFS，3.6对5.3个月；P = 0.3540；OS，36.6对45.4个月；P = 0.8659）。但在INO患者中，与停止IO治疗相比，采用IO维持治疗的中位nPFS和OS显著更长（nPFS，6.1对4.1个月；P = 0.0264；OS，45.4对32.3个月；P = 0.0348）。
结论
LAT（放疗或手术）对REO患者更为重要，而IO维持治疗在INO患者中起更主要作用。
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