对于有脑转移的非小细胞肺癌患者，及时进行放疗和 PD-1/PD-L1 抑制剂治疗可改善生存结局。
Improved survival outcome with not-delayed radiotherapy and immediate PD-1/PD-L1 inhibitor for non-small-cell lung cancer patients with brain metastases.
机构信息
Department of Radiation Oncology (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
出版信息
J Neurooncol. 2023 Oct;165(1):127-137. doi: 10.1007/s11060-023-04459-4. Epub 2023 Oct 17.
PURPOSE
To investigate the impact of radiotherapy (RT) and immune checkpoint inhibitor (ICI) sequence on the survival outcome in NSCLC patients with brain metastasis, and decide the best time to initiate RT.
METHODS
Patients were managed with delayed RT (ICI delivered over 2 weeks prior to RT), concurrent RT (ICI delivered within 2 weeks prior to or after RT), or upfront RT (RT delivered over 2 weeks prior to ICI). Overall survival (OS), intracranial local progression-free survival (iLPFS), and intracranial distant progression-free survival (iDPFS) were assessed. A meta-analysis was performed to analyze the association between survival outcome and RT/ICI sequence.
RESULTS
A total of 73 NSCLC patients were identified with a median follow-up of 13.9 months. Patients who receive delayed RT demonstrated shorter iLPFS (P = 0.0029), iDPFS (P = 0.016), and OS (P < 0.001). A meta-analysis was conducted and a total of 4 studies, 254 patients were included. The HR was 0.44 for iDPFS (P = 0.03), 0.41 for OS (P < 0.01) when compared concurrent with delayed RT, 0.21 for iDPFS (P < 0.01), 0.32 for OS (P < 0.01) when compared upfront with delayed RT, consistent with our conclusion that delayed RT brought with worst iDPFS and OS. More importantly, the best overall response rate (BOR) decreased in cases with longer RT and ICI intervals. Patients who receive intervals of RT and ICI within 7 days achieve the best median BOR of - 53%.
CONCLUSIONS
Delayed RT brought poor survival outcomes including iLPFS, iDPFS, and OS in NSCLC patients. The shorter interval of RT and ICI is associated with better BOR.
目的
研究放疗（RT）和免疫检查点抑制剂（ICI）序贯对非小细胞肺癌脑转移患者生存结局的影响，并确定开始 RT 的最佳时间。
方法
患者接受延迟 RT（ICI 在 RT 前 2 周内给予）、同期 RT（ICI 在 RT 前或后 2 周内给予）或 upfront RT（ICI 在 RT 前 2 周内给予）。评估总生存期（OS）、颅内局部无进展生存期（iLPFS）和颅内远处无进展生存期（iDPFS）。进行荟萃分析以分析生存结局与 RT/ICI 顺序之间的关系。
结果
共纳入 73 例 NSCLC 患者，中位随访时间为 13.9 个月。接受延迟 RT 的患者 iLPFS（P = 0.0029）、iDPFS（P = 0.016）和 OS（P<0.001）较短。进行荟萃分析，共纳入 4 项研究，254 例患者。与同期 RT 相比，iDPFS 的 HR 为 0.44（P = 0.03），OS 的 HR 为 0.41（P<0.01），与延迟 RT 相比，iDPFS 的 HR 为 0.21（P<0.01），OS 的 HR 为 0.32（P<0.01），与我们的结论一致，即延迟 RT 导致最差的 iDPFS 和 OS。更重要的是，RT 和 ICI 间隔时间较长时，总体反应率（BOR）降低。接受 RT 和 ICI 间隔时间在 7 天内的患者，中位 BOR 最佳，为-53%。
结论
延迟 RT 导致 NSCLC 患者 iLPFS、iDPFS 和 OS 等生存结局较差。RT 和 ICI 间隔时间越短，BOR 越好。
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