Wang Qi, Fang Yujia, Li Chunyu, Leong Tracy L, Provencio Mariano, Oh In-Jae, Zhang Zhemin, Su Chunxia
Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University, Tongji University Medical School Cancer Institute, Shanghai, China.
Tongji University, Tongji University Medical School Cancer Institute, Shanghai, China.
Transl Lung Cancer Res. 2023 Feb 28;12(2):312-321. doi: 10.21037/tlcr-23-83. Epub 2023 Feb 25.
Immune checkpoint inhibitors (ICIs) possess remarkable clinical effectiveness in non-small cell lung cancer (NSCLC). Different immune profiles of tumors may play a key role in the efficacy of treatment with ICIs. This article aimed to determine the differential organ responses to ICI in individuals with metastatic NSCLC.
This research analyzed data of advanced NSCLC patients receiving first-line treatment with ICIs. Major organs such as the liver, lung, adrenal glands, lymph nodes and brain were assessed using the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and RECIST-improved organ-specific response criteria.
A retrospective analysis was conducted on a total of 105 individuals with advanced NSCLC with programmed death ligand-1 (PD-L1) expression ≥50% who received single agent anti-programmed cell death protein 1 (PD-1)/PD-L1 monoclonal antibodies as first-line therapy. Overall, 105 (100%), 17 (16.2%), 15 (14.3%), 13 (12.4%), and 45 (42.8%) individuals showed measurable lung tumors and liver, brain, adrenal, and other lymph node metastases at baseline. The median size of the lung, liver, brain, adrenal gland, and lymph nodes were 3.4, 3.1, 2.8, 1.9, and 1.8 cm, respectively. The results recorded mean response times of 2.1, 3.4, 2.5, 3.1, and 2.3 months, respectively. Organ-specific overall response rates (ORRs) were 67%, 30.6%, 34%, 39%, and 59.1%, respectively, with the liver having the lowest remission rate and lung lesions having the highest remission rate. There were 17 NSCLC patients with liver metastasis at baseline, and 6 had different responses to ICI treatment, with remission in the primary lung site and progressive disease (PD) in the metastatic liver site. At baseline, the mean progression-free survival (PFS) of the 17 patients with liver metastasis and 88 patients without liver metastasis was 4.3 and 7 months, respectively (P=0.02, 95% CI: 0.691 to 3.033).
The liver metastases of NSCLC may be less responsive to ICIs than other organs. The lymph nodes respond most favorably to ICIs. Further strategies may include additional local treatment in case of oligoprogression in these organs in patients with otherwise sustained treatment benefit.
免疫检查点抑制剂（ICIs）在非小细胞肺癌（NSCLC）中具有显著的临床疗效。肿瘤不同的免疫特征可能在ICIs治疗疗效中起关键作用。本文旨在确定转移性NSCLC患者对ICI的不同器官反应。
本研究分析了接受ICIs一线治疗的晚期NSCLC患者的数据。使用实体瘤疗效评价标准（RECIST）1.1和改良的RECIST器官特异性反应标准对肝脏、肺、肾上腺、淋巴结和脑等主要器官进行评估。
对总共105例程序性死亡配体-1（PD-L1）表达≥50%的晚期NSCLC患者进行回顾性分析，这些患者接受单药抗程序性细胞死亡蛋白1（PD-1）/PD-L1单克隆抗体作为一线治疗。总体而言，105例（100%）、17例（16.2%）、15例（14.3%）、13例（12.4%）和45例（42.8%）患者在基线时显示有可测量的肺肿瘤以及肝、脑、肾上腺和其他淋巴结转移。肺、肝、脑、肾上腺和淋巴结的中位大小分别为3.4、3.1、2.8、1.9和1.8厘米。结果记录的平均反应时间分别为2.1、3.4、2.5、3.1和2.3个月。器官特异性总缓解率（ORR）分别为67%、30.6%、34%、39%和59.1%，其中肝脏缓解率最低，肺部病变缓解率最高。有17例NSCLC患者在基线时有肝转移，其中6例对ICI治疗有不同反应，原发肺部位缓解而转移肝部位疾病进展（PD）。基线时，17例有肝转移患者和88例无肝转移患者的平均无进展生存期（PFS）分别为4.3个月和7个月（P = 0.02，95%CI：0.691至3.033）。
NSCLC的肝转移对ICIs的反应可能低于其他器官。淋巴结对ICIs反应最良好。对于在其他方面有持续治疗获益的患者，如果这些器官出现寡进展，进一步的策略可能包括额外的局部治疗。
