纳武利尤单抗治疗不可切除的晚期或复发性食管癌患者免疫相关不良反应后的再次挑战。
Nivolumab Rechallenge After Immune-related Adverse Events in Patients With Unresectable Advanced or Recurrent Esophageal Cancer.
机构信息
Department of Esophageal Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Department of Esophageal Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
出版信息
In Vivo. 2024 Mar-Apr;38(2):794-799. doi: 10.21873/invivo.13503.
BACKGROUND/AIM: Rechallenge with immune checkpoint inhibitors following immune-related adverse events (irAEs) during the treatment of certain cancers reportedly has good efficacy. However, the subsequent clinical course of esophageal cancer remains unclear. This study investigated the nature of irAEs and the efficacy of a nivolumab rechallenge for patients with esophageal cancer.
PATIENTS AND METHODS
This study retrospectively analyzed 44 patients with unresectable advanced or recurrent esophageal cancer who were treated with nivolumab as a second-line or later regimen and developed irAEs between February 2020 and May 2022. The cohort was divided into continuation, rechallenge, and discontinuation groups based on nivolumab administration after the occurrence of irAEs. The proportion of each group was investigated according to the type of irAEs. The progression-free and overall survival periods were retrospectively analyzed for each group.
RESULTS
Among patients with skin-related irAEs, 78.6% continued nivolumab administration, 14.3% rechallenged, and 7.1% discontinued nivolumab. Among patients with gastrointestinal disorders, 30.8% continued, 46.2% rechallenged, and 23.1% discontinued nivolumab. Among patients with interstitial pneumonia, none continued, 55.6% rechallenged, and 44.4% discontinued nivolumab. In those with endocrine disorders, 83.3% continued, none rechallenged, and 16.7% discontinued nivolumab. The median progression-free survival after irAE occurrence in the continuation, rechallenge, and discontinuation groups was 210, 333, and 72.5 days, respectively (p=0.022), while the median overall survival after irAE occurrence was 714, 848, and 223 days, respectively (p=0.008).
CONCLUSION
Rechallenge with nivolumab may be considerably effective, depending on the type and severity of irAEs, and may improve the prognosis of patients with unresectable advanced or recurrent esophageal cancer.
背景/目的：据报道，在治疗某些癌症时，针对免疫相关不良反应（irAEs）再次使用免疫检查点抑制剂具有良好的疗效。然而，食管癌患者的后续临床过程仍不清楚。本研究调查了食管癌患者 irAEs 的性质和 nivolumab 再次挑战的疗效。
患者和方法
本研究回顾性分析了 2020 年 2 月至 2022 年 5 月期间，44 例接受 nivolumab 二线或更后治疗的不可切除的晚期或复发性食管癌患者，这些患者在治疗过程中发生了 irAEs。根据 irAEs 发生后 nivolumab 的使用情况，将队列分为继续、再挑战和停药组。根据 irAEs 的类型，调查了每组的比例。对每组患者的无进展生存期和总生存期进行了回顾性分析。
结果
皮肤相关 irAEs 患者中，78.6%继续使用 nivolumab，14.3%再次挑战，7.1%停止使用 nivolumab。胃肠道疾病患者中，30.8%继续使用，46.2%再次挑战，23.1%停止使用 nivolumab。间质性肺炎患者中，无一例继续使用，55.6%再次挑战，44.4%停止使用 nivolumab。内分泌疾病患者中，83.3%继续使用，无一例再次挑战，16.7%停止使用 nivolumab。irAE 发生后继续、再挑战和停药组的中位无进展生存期分别为 210、333 和 72.5 天（p=0.022），irAE 发生后中位总生存期分别为 714、848 和 223 天（p=0.008）。
结论
根据 irAEs 的类型和严重程度，再次使用 nivolumab 可能具有显著疗效，并可能改善不可切除的晚期或复发性食管癌患者的预后。
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