Luo Shilan, Li Peng, Zhang Anqi, Meng Lu, Huang Litang, Wu Xiaoting, Cheng Hongxia, Tu Hongbin, Gong Xiaomei
Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Integrated TCM & Western Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Int Immunopharmacol. 2024 Mar 30;130:111705. doi: 10.1016/j.intimp.2024.111705. Epub 2024 Feb 26.
To evaluate the therapeutic advantage of G-CSF to whole brain radiotherapy (WBRT) in combination with immunotherapy as a first-line treatment for non-small cell lung cancer (NSCLC) brain metastases (BMs).
In this retrospective study, 117 patients (37 in G-CSF group and 80 in no G-CSF group) who underwent first-line WBRT combined with immunotherapy were enrolled. Their survival, intracranial response, BM-related symptoms and toxicity were evaluated.
The overall survival (OS) of patients in G-CSF group was significantly improved compared to patients no G-CSF group (median time: 14.8 vs 10.2 months; HR: 0.61, 95 % CI: 0.38-0.97, p = 0.035). However, there were no significant differences in intracranial responses between the two groups (p > 0.05). The G-CSF group exhibited a significantly higher rate of relief from BM-related symptoms compared to the no G-CSF group (91.7 % vs 59.5 %, p = 0.037). Cox proportional hazards regression analyses indicated that after-treatment ALC > 0.9 × 10^9/L (HR 0.57, 95 % CI 0.32-0.99, p = 0.046) and Hb > 110 g/dL (HR 0.41, 95 % CI 0.24-0.71, p = 0.001) were significant potential factors associated with extended OS. The addition of G-CSF was well tolerated and effectively reduced the incidence of neutropenia (0 % vs 5.0 %, p = 0.17).
Integrating G-CSF with WBRT and immunotherapy as a first-line treatment for NSCLC-BMs has exhibited significant efficacy and favorable tolerability.
评估粒细胞集落刺激因子（G-CSF）联合全脑放疗（WBRT）与免疫疗法作为非小细胞肺癌（NSCLC）脑转移瘤（BMs）一线治疗方案的治疗优势。
在这项回顾性研究中，纳入了117例接受一线WBRT联合免疫疗法的患者（G-CSF组37例，非G-CSF组80例）。评估了他们的生存期、颅内反应、BM相关症状及毒性。
与非G-CSF组患者相比，G-CSF组患者的总生存期（OS）显著改善（中位时间：14.8个月对10.2个月；风险比：0.61，95%置信区间：0.38 - 0.97，p = 0.035）。然而，两组之间的颅内反应无显著差异（p > 0.05）。与非G-CSF组相比，G-CSF组BM相关症状缓解率显著更高（91.7%对59.5%，p = 0.037）。Cox比例风险回归分析表明，治疗后绝对淋巴细胞计数（ALC）> 0.9×10^9/L（风险比0.57，95%置信区间0.32 - 0.99，p = 0.046）和血红蛋白（Hb）> 110 g/dL（风险比0.41，95%置信区间0.24 - 0.71，p = 0.001）是与延长OS相关的显著潜在因素。添加G-CSF耐受性良好，并有效降低了中性粒细胞减少的发生率（0%对5.0%，p = 0.17）。
将G-CSF与WBRT及免疫疗法联合作为NSCLC-BMs的一线治疗方案已显示出显著疗效和良好耐受性。
