临床因素对老年非小细胞肺癌且PD-L1肿瘤比例评分≥50患者接受或不接受化疗的免疫检查点抑制剂治疗的预后影响
Prognostic impact of clinical factors for immune checkpoint inhibitor with or without chemotherapy in older patients with non-small cell lung cancer and PD-L1 TPS ≥ 50.
作者信息
Takei Shota, Kawachi Hayato, Yamada Tadaaki, Tamiya Motohiro, Negi Yoshiki, Goto Yasuhiro, Nakao Akira, Shiotsu Shinsuke, Tanimura Keiko, Takeda Takayuki, Okada Asuka, Harada Taishi, Date Koji, Chihara Yusuke, Hasegawa Isao, Tamiya Nobuyo, Katayama Yuki, Nishioka Naoya, Morimoto Kenji, Iwasaku Masahiro, Tokuda Shinsaku, Kijima Takashi, Takayama Koichi
机构信息
Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan.
出版信息
Front Immunol. 2024 Feb 23;15:1348034. doi: 10.3389/fimmu.2024.1348034. eCollection 2024.
INTRODUCTION
The proportion of older patients diagnosed with advanced-stage non-small cell lung cancer (NSCLC) has been increasing. Immune checkpoint inhibitor (ICI) monotherapy (MONO) and combination therapy of ICI and chemotherapy (COMBO) are standard treatments for patients with NSCLC and programmed cell death ligand-1 (PD-L1) tumor proportion scores (TPS) ≥ 50%. However, evidence from the clinical trials specifically for older patients is limited. Thus, it is unclear which older patients benefit more from COMBO than MONO.
METHODS
We retrospectively analyzed 199 older NSCLC patients of Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 and PD-L1 TPS ≥ 50% who were treated with MONO or COMBO. We analyzed the association between treatment outcomes and baseline patient characteristics in each group, using propensity score matching.
RESULTS
Of the 199 patients, 131 received MONO, and 68 received COMBO. The median overall survival (OS; MONO: 25.2 vs. COMBO: 42.2 months, P = 0.116) and median progression-free survival (PFS; 10.9 vs. 11.8 months, P = 0.231) did not significantly differ between MONO and COMBO group. In the MONO group, OS was significantly shorter in patients without smoking history compared to those with smoking history [HR for smoking history against non-smoking history: 0.36 (95% CI: 0.16-0.78), P = 0.010]. In the COMBO group, OS was significantly shorter in patients with PS 1 than those with PS 0 [HR for PS 0 against PS 1: 3.84 (95% CI: 1.44-10.20), P = 0.007] and for patients with squamous cell carcinoma (SQ) compared to non-squamous cell carcinoma (non-SQ) [HR for SQ against non-SQ: 0.17 (95% CI: 0.06-0.44), P < 0.001]. For patients with ECOG PS 0 (OS: 26.1 months vs. not reached, P = 0.0031, PFS: 6.5 vs. 21.7 months, P = 0.0436) or non-SQ (OS: 23.8 months vs. not reached, P = 0.0038, PFS: 10.9 vs. 17.3 months, P = 0.0383), PFS and OS were significantly longer in the COMBO group.
CONCLUSIONS
ECOG PS and histological type should be considered when choosing MONO or COMBO treatment in older patients with NSCLC and PD-L1 TPS ≥ 50%.
引言
被诊断为晚期非小细胞肺癌（NSCLC）的老年患者比例一直在增加。免疫检查点抑制剂（ICI）单药治疗（MONO）以及ICI与化疗的联合治疗（COMBO）是NSCLC且程序性细胞死亡配体-1（PD-L1）肿瘤比例评分（TPS）≥50%患者的标准治疗方法。然而，专门针对老年患者的临床试验证据有限。因此，尚不清楚哪些老年患者从COMBO治疗中比从MONO治疗中获益更多。
方法
我们回顾性分析了199例东部肿瘤协作组体能状态（ECOG PS）为0-1且PD-L1 TPS≥50%的老年NSCLC患者，这些患者接受了MONO或COMBO治疗。我们使用倾向评分匹配分析了每组治疗结果与基线患者特征之间的关联。
结果
199例患者中，131例接受了MONO治疗，68例接受了COMBO治疗。MONO组和COMBO组的中位总生存期（OS；MONO组：25.2个月 vs. COMBO组：42.2个月，P = 0.116）和中位无进展生存期（PFS；10.9个月 vs. 11.8个月，P = 0.231）无显著差异。在MONO组中，无吸烟史患者的OS明显短于有吸烟史患者[有吸烟史与无吸烟史的风险比（HR）：0.36（95%置信区间：0.16-0.78），P = 0.010]。在COMBO组中，PS为1的患者的OS明显短于PS为0的患者[PS为0与PS为1的HR：3.84（95%置信区间：1.44-10.20），P = 0.007]，鳞状细胞癌（SQ）患者的OS明显短于非鳞状细胞癌（非SQ）患者[SQ与非SQ的HR：0.17（95%置信区间：0.06-0.44），P < 0.001]。对于ECOG PS为0（OS：26.1个月 vs. 未达到，P = 0.0031，PFS：6.5个月 vs. 21.7个月，P = 0.0436）或非SQ（OS：23.8个月 vs. 未达到，P = 0.0038，PFS：10.9个月 vs. 17.3个月，P = 0.0383）的患者，COMBO组的PFS和OS明显更长。
结论
在选择对NSCLC且PD-L1 TPS≥50%的老年患者进行MONO或COMBO治疗时，应考虑ECOG PS和组织学类型。
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