Wei Kunchen, Zhou Chao, Chen Yang, Feng Xiao, Tang Hao
Department of Respiratory and Critical Care Medicine, Changzheng Hospital, Navy Medical University, Shanghai, China.
Front Oncol. 2023 Jul 18;13:1217872. doi: 10.3389/fonc.2023.1217872. eCollection 2023.
Programmed cell death-1 (PD-1) and its ligand 1 (PD-L1) inhibitors have achieved good efficacy and safety in patients with advanced EGFR mutation-negative non-small cell lung cancer (NSCLC), but their efficacy in patients with previous EGFR mutations is limited. The aim of the present study was to explore the efficacy of PD-1/L1 immune checkpoint inhibitors for the treatment of patients with advanced NSCLC who are resistant to EGFR-TKIs.
This retrospective study included 123 patients with stage IV NSCLC who received treatment in Shanghai Changzheng Hospital between January 2019 and January 2022 after failure of first-line EGFR-TKIs. Of them, 39 received ICIs + chemotherapy and anti-angiogenic drugs (ICIs+BCP group), 51 received ICIs monotherapy (ICIs group), and 33 received chemotherapy and anti-angiogenic drugs (BCP group). The gender, age, smoking history, ECOG score, EGFR mutation type, PD-L1 TPS expression, and the first routine blood index before second-line treatment of all enrolled patients were recorded, and their clinical outcomes and prognosis factors were analyzed.
There was no significant difference in the objective response rate (ORR) and disease control rate (DCR) between the three groups. Patients in ICIs+BCP group had better prognosis than those in ICIs monotherapy group (PFS:9.5 4.64 months, p<0.001; OS: 16.97 7.9 months p<0.001) or BCP group (9.5 6.48 months, p<0.005; OS: 16.97 11.39 months p<0.005).
Our findings suggest that in the real-world practice in China, PD-1/L1 immune checkpoint inhibitors combined with chemotherapy and anti-angiogenic drugs are effective for the treatment of patients with advanced NSCLC who are resistant to EGFR-TKIs.
程序性细胞死亡蛋白1（PD-1）及其配体1（PD-L1）抑制剂在晚期表皮生长因子受体（EGFR）突变阴性的非小细胞肺癌（NSCLC）患者中已取得良好的疗效和安全性，但它们在既往有EGFR突变的患者中的疗效有限。本研究的目的是探讨PD-1/L1免疫检查点抑制剂治疗对EGFR酪氨酸激酶抑制剂（EGFR-TKIs）耐药的晚期NSCLC患者的疗效。
本回顾性研究纳入了2019年1月至2022年1月在上海长征医院接受一线EGFR-TKIs治疗失败后接受治疗的123例IV期NSCLC患者。其中，39例接受免疫检查点抑制剂（ICIs）+化疗和抗血管生成药物（ICIs+BCP组），51例接受ICIs单药治疗（ICIs组），33例接受化疗和抗血管生成药物（BCP组）。记录所有入组患者的性别、年龄、吸烟史、东部肿瘤协作组（ECOG）评分、EGFR突变类型、PD-L1肿瘤比例评分（TPS）表达以及二线治疗前的首次血常规指标，并分析其临床结局和预后因素。
三组间的客观缓解率（ORR）和疾病控制率（DCR）无显著差异。ICIs+BCP组患者的预后优于ICIs单药治疗组（无进展生存期[PFS]：9.5±4.64个月，p<0.001；总生存期[OS]：16.97±7.9个月，p<0.001）或BCP组（PFS：9.5±6.48个月，p<0.005；OS：16.97±11.39个月，p<0.005）。
我们的研究结果表明，在中国现实世界的实践中，PD-1/L1免疫检查点抑制剂联合化疗和抗血管生成药物对治疗对EGFR-TKIs耐药的晚期NSCLC患者有效。
