Wu Leilei, Cheng Bo, Sun Xiaojiang, Zhang Zhenshan, Kang Jingjing, Chen Yun, Xu Qinghua, Yang Shuangyan, Yan Yujie, Ren Shengxiang, Zhou Caicun, Xu Yaping
Department of Radiation Oncology Shanghai Pulmonary Hospital School of Medicine Tongji University Shanghai China.
Department of Radiation Oncology Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Institute of Cancer and Basic Medicine (IBMC) Chinese Academy of Sciences Hangzhou China.
MedComm (2020). 2024 Mar 2;5(3):e501. doi: 10.1002/mco2.501. eCollection 2024 Mar.
This study aimed to evaluate the efficacy and safety of induction immunochemotherapy followed by definitive chemoradiotherapy (CRT) for unresectable locally advanced non-small cell lung cancer (LA-NSCLC). We identified unresectable stage III NSCLC patients who received induction immunochemotherapy. Overall survival (OS) and progression-free survival (PFS) were the primary endpoints. From February 2019 to August 2022, 158 patients were enrolled. Following the completion of induction immunochemotherapy, the objective response rate (ORR) and disease control rate (DCR) were 52.5% and 83.5%, respectively. The ORR of CRT was 73.5%, representing 68.4% of the total cohort. The median PFS was 17.8 months, and the median OS was 41.9 months, significantly higher than in patients who received CRT alone ( < 0.001). Patients with concurrent CRT demonstrated markedly improved PFS ( = 0.012) and OS ( = 0.017) than those undergoing sequential CRT. Additionally, those with a programmed-death ligand 1 (PD-L1) expression of 50% or higher showed significantly elevated ORRs (72.2% vs. 47.2%, = 0.011) and superior OS (median 44.8 vs. 28.6 months, = 0.004) compared to patients with PD-L1 expression below 50%. Hematologic toxicities were the primary severe adverse events (grade ≥ 3) encountered, with no unforeseen treatment-related toxicities. Thus, induction immunochemotherapy followed by definitive CRT demonstrated encouraging efficacy and tolerable toxicities for unresectable LA-NSCLC.
本研究旨在评估诱导免疫化疗序贯根治性放化疗（CRT）治疗不可切除的局部晚期非小细胞肺癌（LA-NSCLC）的疗效和安全性。我们纳入了接受诱导免疫化疗的不可切除的Ⅲ期NSCLC患者。总生存期（OS）和无进展生存期（PFS）为主要终点。2019年2月至2022年8月，共纳入158例患者。诱导免疫化疗完成后，客观缓解率（ORR）和疾病控制率（DCR）分别为52.5%和83.5%。CRT的ORR为73.5%，占总队列的68.4%。中位PFS为17.8个月，中位OS为41.9个月，显著高于单纯接受CRT的患者（<0.001）。同步进行CRT的患者的PFS（=0.012）和OS（=0.017）明显优于序贯进行CRT的患者。此外，程序性死亡配体1（PD-L1）表达≥50%的患者与PD-L1表达<50%的患者相比，ORR显著升高（72.2%对47.2%，=0.011），OS也更优（中位44.8个月对28.6个月，=0.004）。血液学毒性是主要的严重不良事件（≥3级），未出现意外的治疗相关毒性。因此，诱导免疫化疗序贯根治性CRT对不可切除的LA-NSCLC显示出令人鼓舞的疗效和可耐受的毒性。
