Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China.
JCO Precis Oncol. 2023 Mar;7:e2200614. doi: 10.1200/PO.22.00614.
Immune checkpoint inhibitors (ICIs) exert robust antitumor activity in non-small-cell lung cancer (NSCLC) without actionable mutations. Apart from isolated case reports, the efficacy of PD-1 blockade in -rearranged NSCLC is currently unknown.
This retrospective cohort study included 23 patients with -rearranged advanced lung adenocarcinoma who received ICI plus chemotherapy regardless of the treatment setting. ICI plus chemotherapy was received as a later-line regimen by 14 patients, as the first-line regimen by six patients, and after chemoradiotherapy by three patients.
All three patients who received chemoradiotherapy followed by ICI plus chemotherapy achieved partial response (PR) and had a progression-free survival (PFS) of >17.9 months. Of the six patients who received first-line ICI plus chemotherapy, five patients achieved PR and one had stable disease (SD), with a median PFS of 24.3 months (95% CI, 4.9 to 43.7). Of the 14 previously treated patients who received later-line ICI plus chemotherapy, the Objective Response Rate (ORR) was 28.6%, the Disease Control Rate (DCR) was 92.9%, and the median PFS was 5.8 months (95% CI, 0.2 to 9.4). The median time on ICI therapy was 10.0 months (95% CI, 1.5 to 32.5). The duration of response was 24.3 months (95% CI, 5.4 to 43.2) and 4.8 months (95% CI, 2.3 to 12.7) for first-line (n = 5) and subsequent-line (n = 4) ICI plus chemotherapy, respectively. Of the 10 patients with brain metastasis before receiving ICI plus chemotherapy, four patients achieved intracranial PR and five patients achieved intracranial SD, achieving an intracranial ORR of 40.0% and an intracranial DCR of 90.0%.
Our retrospective study provides real-world clinical evidence that -rearranged NSCLCs benefit from ICI plus chemotherapy in any treatment setting, including patients who present with brain metastasis.
免疫检查点抑制剂（ICI）在没有可操作突变的非小细胞肺癌（NSCLC）中具有强大的抗肿瘤活性。除了孤立的病例报告外，目前尚不清楚 PD-1 阻断在 -重排 NSCLC 中的疗效。
这项回顾性队列研究纳入了 23 名接受 ICI 联合化疗治疗的 -重排晚期肺腺癌患者，无论治疗方案如何。14 名患者接受 ICI 联合化疗作为后线治疗方案，6 名患者接受 ICI 联合化疗作为一线治疗方案，3 名患者在放化疗后接受 ICI 联合化疗。
所有 3 名接受放化疗后接受 ICI 联合化疗的患者均达到部分缓解（PR），无进展生存期（PFS）超过 17.9 个月。6 名接受一线 ICI 联合化疗的患者中，5 名患者达到 PR，1 名患者病情稳定（SD），中位 PFS 为 24.3 个月（95%CI，4.9 至 43.7）。14 名接受后线 ICI 联合化疗的既往治疗患者的客观缓解率（ORR）为 28.6%，疾病控制率（DCR）为 92.9%，中位 PFS 为 5.8 个月（95%CI，0.2 至 9.4）。ICI 治疗的中位时间为 10.0 个月（95%CI，1.5 至 32.5）。一线（n=5）和后线（n=4）ICI 联合化疗的缓解持续时间分别为 24.3 个月（95%CI，5.4 至 43.2）和 4.8 个月（95%CI，2.3 至 12.7）。在接受 ICI 联合化疗之前有脑转移的 10 名患者中，4 名患者颅内达到 PR，5 名患者颅内达到 SD，颅内客观缓解率（ORR）为 40.0%，颅内疾病控制率（DCR）为 90.0%。
我们的回顾性研究提供了真实世界的临床证据，表明 -重排 NSCLC 从 ICI 联合化疗中获益，无论治疗方案如何，包括有脑转移的患者。
