Wei Jingwen, Xiang Jing, Hao Yue, Si Jinfei, Gu Xiaodong, Xu Manyi, Song Zhengbo
Department of Clinical Trial, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China.
Wenzhou Medical University, Wenzhou, China.
J Thorac Dis. 2023 Feb 28;15(2):260-269. doi: 10.21037/jtd-22-1011. Epub 2023 Jan 9.
Primary adenosquamous carcinoma (ASC) of the lung is a rare and aggressive disease and limited information is available on the efficacy of immune checkpoint inhibitors (ICIs) for this disease. Here, we evaluated the expression status of programmed death-1 ligand 1 (PD-L1) and efficacy of ICIs in patients with pulmonary ASC.
The efficacy and toxicity of ICIs were examined in 38 patients with previously treated lung ASC from November 2017 to October 2021 in Zhejiang Cancer Hospital (Hangzhou, China). Survival curves were plotted using the Kaplan-Meier method and the Cox proportional hazards model applied for univariate and multivariate analyses.
A total of 38 patients with ASC were included in this retrospective study. ICI treatment induced an objective response rate (ORR) of 23.7% and a disease control rate (DCR) of 86.8%. The median progression-free survival (PFS) and median overall survival (OS) were 5.47 and 24.10 months, respectively. Seventeen patients were successfully evaluated for PD-L1 expression status, with 11 (64.7%) identified as PD-L1-positive. ORR and DCR for PD-L1-positive patients were 36.4% (4/11) and 100% (11/11) and the corresponding values for PD-L1-negative patients were 0 (0/6) and 50% (3/6), respectively. The median PFS of PD-L1-positive and PD-L1-negative patient groups was 5.00 and 1.90 months (P=0.166) while the median OS was 11.30 months and not reached, respectively (P=0.966). The incidence rate of immune-related adverse events (irAEs) was 52.6%, with 13.2% grade 3-4 irAEs. The most common irAEs were malaise and pneumonitis. One patient died of pneumonitis during the study.
ICIs show considerable potential as a treatment option for lung ASC. PFS and OS rates are similar for PD-L1-positive and PD-L1-negative patients. Further large-scale studies are required to establish the relationship between PD-L1 expression and response to ICIs in ASC.
原发性肺腺鳞癌（ASC）是一种罕见且侵袭性强的疾病，关于免疫检查点抑制剂（ICI）治疗该疾病的疗效信息有限。在此，我们评估了程序性死亡-1配体1（PD-L1）的表达状态以及ICI在肺ASC患者中的疗效。
2017年11月至2021年10月期间，在浙江省肿瘤医院（中国杭州）对38例既往接受过治疗的肺ASC患者的ICI疗效和毒性进行了研究。采用Kaplan-Meier方法绘制生存曲线，并应用Cox比例风险模型进行单因素和多因素分析。
本回顾性研究共纳入38例ASC患者。ICI治疗的客观缓解率（ORR）为23.7%，疾病控制率（DCR）为86.8%。中位无进展生存期（PFS）和中位总生存期（OS）分别为5.47个月和24.10个月。17例患者成功评估了PD-L1表达状态，其中11例（64.7%）为PD-L1阳性。PD-L1阳性患者的ORR和DCR分别为36.4%（4/11）和100%（11/11），而PD-L1阴性患者的相应值分别为0（0/6）和50%（3/6）。PD-L1阳性和PD-L1阴性患者组的中位PFS分别为5.00个月和1.90个月（P=0.166），而中位OS分别为11.30个月和未达到（P=0.966）。免疫相关不良事件（irAE）的发生率为52.6%，3-4级irAE的发生率为13.2%。最常见的irAE是乏力和肺炎。1例患者在研究期间死于肺炎。
ICI作为肺ASC的一种治疗选择显示出相当大的潜力。PD-L1阳性和PD-L1阴性患者的PFS和OS率相似。需要进一步开展大规模研究以确定ASC中PD-L1表达与对ICI反应之间的关系。
