Kuge Tomoki, Shiroyama Takayuki, Tamiya Akihiro, Tamiya Motohiro, Kanazu Masaki, Kinehara Yuhei, Tanaka Tsunehiro, Morimura Osamu, Taniguchi Yoshihiko, Niki Toshie, Tetsumoto Satoshi, Hayashi Kazuhiko, Nishino Kazumi, Nagatomo Izumi, Kumanogoh Atsushi
Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan.
JTO Clin Res Rep. 2023 Mar 23;4(5):100505. doi: 10.1016/j.jtocrr.2023.100505. eCollection 2023 May.
Durvalumab maintenance therapy after definitive concurrent chemoradiotherapy (CRT) is the standard treatment modality for stage III NSCLC. Although severe treatment-related lymphopenia (TRL) during CRT may impair the efficacy of subsequent durvalumab therapy, data on the effect of TRL recovery on consolidation durvalumab therapy are lacking.
This retrospective study evaluated patients with unresectable stage III NSCLC treated with durvalumab after concurrent CRT. The patients were enrolled across nine institutes throughout Japan between August 2018 and March 2020. The effect of TRL recovery on survival was evaluated. The patients were divided into two groups on the basis of their lymphocyte recovery status: the recovery group involved patients who did not experience severe TRL or experienced TRL but exhibited lymphocyte count recovery at durvalumab initiation, and the nonrecovery group involved patients who experienced severe TRL and did not exhibit lymphocyte count recovery on durvalumab initiation.
Among the 151 patients evaluated, 41 (27%) and 110 (73%) patients were classified into the recovery and the nonrecovery groups, respectively. The nonrecovery group had significantly worse progression-free survival than the recovery group (21.9 mo versus not reached, = 0.018). Recovery from TRL ( = 0.027) and high pre-CRT lymphocyte count ( = 0.028) independently influenced progression-free survival.
Baseline lymphocyte count and recovery from TRL at the start of durvalumab therapy were predictive factors for survival outcomes in patients with NSCLC treated with durvalumab consolidation after concurrent CRT.
对于 III 期非小细胞肺癌（NSCLC）患者，在根治性同步放化疗（CRT）后使用度伐利尤单抗进行维持治疗是标准的治疗模式。尽管在 CRT 期间严重的治疗相关淋巴细胞减少（TRL）可能会削弱后续度伐利尤单抗治疗的疗效，但关于 TRL 恢复对巩固性度伐利尤单抗治疗效果的数据尚缺乏。
这项回顾性研究评估了在同步 CRT 后接受度伐利尤单抗治疗的不可切除 III 期 NSCLC 患者。2018 年 8 月至 2020 年 3 月期间，在日本全国九家机构招募了这些患者。评估了 TRL 恢复对生存的影响。根据淋巴细胞恢复状态将患者分为两组：恢复组包括未经历严重 TRL 或经历了 TRL 但在开始使用度伐利尤单抗时淋巴细胞计数恢复的患者，非恢复组包括经历了严重 TRL 且在开始使用度伐利尤单抗时未出现淋巴细胞计数恢复的患者。
在评估的 151 例患者中，分别有 41 例（27%）和 110 例（73%）患者被分类为恢复组和非恢复组。非恢复组的无进展生存期明显差于恢复组（21.9 个月对未达到，P = 0.018）。TRL 的恢复（P = 0.027）和 CRT 前淋巴细胞计数高（P = 0.028）独立影响无进展生存期。
基线淋巴细胞计数以及在度伐利尤单抗治疗开始时 TRL 的恢复是同步 CRT 后接受度伐利尤单抗巩固治疗的 NSCLC 患者生存结果的预测因素。
