Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Imaging, Jiangsu Vocational College of Medicine Affiliated Dongtai People's Hospital, Kangfu West Road 2, Dongtai, Jiangsu Province, 224000, China.
World J Surg Oncol. 2023 Jul 27;21(1):228. doi: 10.1186/s12957-023-03122-6.
Anti-programmed death 1/anti-programmed death ligand 1 (PD-1/PD-L1) combined with radiotherapy (RT) has a synergistic effect on systemic tumor control. A dissociated response (DR), characterized by some lesions shrinking and others growing, has been recognized with immune checkpoint inhibitor (ICI) monotherapy or combination therapy. The objective of this study was to assess the frequency and clinical benefit of DR in patients with advanced metastatic solid tumors receiving PD-1 inhibitors in combination with RT.
We conducted a single-center retrospective analysis of patients with advanced metastatic solid tumors receiving PD-1 inhibitor combined with RT at the Department of Radiotherapy & Oncology, The Second People's Hospital Affiliated with Soochow University. Treatment response was assessed for each measurable lesion according to the Response Evaluation Criteria in Solid Tumours ( RECIST) v 1.1 guidelines. Patterns of response are divided into four groups: (1) DR, (2) uniform response, (3) uniform progression, and (4) only stable lesions. The overall survival (OS) of different groups was compared using Kaplan-Meier methods and log-rank tests.
Between March 2019 and July 2022, 93 patients were included. The median follow-up was 10.5 months (95% CI 8.8-12.1). The most common tumor types were lung cancer (19.8%), colorectal adenocarcinoma (17.2%), and esophageal cancer (10.8%). DR was observed in 22 (23.7%) patients. The uniform progression and DR are two different patterns of progression. After confirming progression, the overall survival of patients with DR was significantly longer than that of patients with uniform progression (9.9 months (95%CI 5.7-14.1) vs. 4.2 months (95%CI 1.9-6.5), P = 0.028). Compared with DR patients who did not continue PD-1 inhibitor combined with RT or PD-1 inhibitor monotherapy (n = 12), DR patients who continued treatment (n = 10) had significantly longer OS (15.7 (95%CI 3.5-27.9) vs 8.2 (95%CI 5.6-10.8) months, P = 0.035).
DR is not uncommon (23.7%) in patients with advanced metastatic solid tumors treated with PD-1 inhibitors combined with RT and shows a relatively favorable prognosis. Some patients with DR may benefit from continued PD-1 inhibitor therapy in combination with RT or PD-1 inhibitor monotherapy and may have longer OS.
抗程序性死亡 1/抗程序性死亡配体 1（PD-1/PD-L1）联合放疗（RT）对全身肿瘤控制具有协同作用。免疫检查点抑制剂（ICI）单药或联合治疗已认识到分离反应（DR），其特征为一些病变缩小而另一些病变增大。本研究旨在评估 PD-1 抑制剂联合 RT 治疗晚期转移性实体瘤患者中 DR 的频率和临床获益。
我们对苏州大学附属第二人民医院放疗科接受 PD-1 抑制剂联合 RT 治疗的晚期转移性实体瘤患者进行了单中心回顾性分析。根据实体瘤反应评估标准（RECIST）v1.1 指南，对每个可测量病变进行治疗反应评估。反应模式分为四组：（1）DR，（2）均匀反应，（3）均匀进展，和（4）仅稳定病变。使用 Kaplan-Meier 方法和对数秩检验比较不同组的总生存期（OS）。
2019 年 3 月至 2022 年 7 月期间，共纳入 93 例患者。中位随访时间为 10.5 个月（95%CI 8.8-12.1）。最常见的肿瘤类型是肺癌（19.8%）、结直肠癌（17.2%）和食管癌（10.8%）。22 例（23.7%）患者观察到 DR。均匀进展和 DR 是两种不同的进展模式。在确认进展后，DR 患者的总生存期明显长于均匀进展患者（9.9 个月（95%CI 5.7-14.1） vs. 4.2 个月（95%CI 1.9-6.5），P=0.028）。与未继续 PD-1 抑制剂联合 RT 或 PD-1 抑制剂单药治疗的 DR 患者（n=12）相比，继续治疗的 DR 患者（n=10）的 OS 明显更长（15.7（95%CI 3.5-27.9） vs 8.2（95%CI 5.6-10.8）个月，P=0.035）。
在接受 PD-1 抑制剂联合 RT 治疗的晚期转移性实体瘤患者中，DR 并不少见（23.7%），且表现出相对有利的预后。一些 DR 患者可能受益于继续 PD-1 抑制剂联合 RT 或 PD-1 抑制剂单药治疗，且可能具有更长的 OS。
