免疫检查点抑制剂联合化疗作为伴恶性胸腔积液的非小细胞肺癌一线治疗：一项回顾性多中心研究。
Immune checkpoint inhibitor plus chemotherapy as first-line treatment for non-small cell lung cancer with malignant pleural effusion: a retrospective multicenter study.
机构信息
Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, Institute of Respiratory Health and Multimorbidity, Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Network, Precision Medicine Center/Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
BMC Cancer. 2024 Mar 28;24(1):393. doi: 10.1186/s12885-024-12173-1.
BACKGROUND
Immune checkpoint inhibitors (ICI) combined with chemotherapy are efficacious for treating advanced non-small cell lung cancer (NSCLC); however, the effectiveness of this approach in the malignant pleural effusion (MPE) population is unclear. This study evaluated ICI plus chemotherapy in NSCLC patients with MPE.
METHODS
Patients from 3 centers in China with NSCLC and MPE who received ICI plus chemotherapy (ICI Plus Chemo) or chemotherapy alone (Chemo) between December 2014 and June 2023 were enrolled. Clinical outcomes and adverse events (AEs) were compared.
RESULTS
Of 155 eligible patients, the median age was 61.0 years old. Males and never-smokers accounted for 73.5% and 39.4%, respectively. Fifty-seven and 98 patients received ICI Plus Chemo or Chemo, respectively. With a median study follow-up of 10.8 months, progression-free survival (PFS) was significantly longer with ICI Plus Chemo than with Chemo (median PFS: 7.4 versus 5.7 months; HR = 0.594 [95% CI: 0.403-0.874], P = 0.008). Median overall survival (OS) did not differ between groups (ICI Plus Chemo: 34.2 versus Chemo: 28.3 months; HR = 0.746 [95% CI: 0.420-1.325], P = 0.317). The most common grade 3 or worse AEs included decreased neutrophil count (3 [5.3%] patients in the ICI Plus Chemo group vs. 5 [5.1%] patients in the Chemo group) and decreased hemoglobin (3 [5.3%] versus 10 [10.2%]).
CONCLUSIONS
In patients with untreated NSCLC with MPE, ICI plus chemotherapy resulted in significantly longer PFS than chemotherapy and had a manageable tolerability profile, but the effect on OS may be limited.
背景
免疫检查点抑制剂（ICI）联合化疗对治疗晚期非小细胞肺癌（NSCLC）有效；然而，这种方法在恶性胸腔积液（MPE）人群中的效果尚不清楚。本研究评估了 ICI 联合化疗在 NSCLC 合并 MPE 患者中的疗效。
方法
本研究纳入了 2014 年 12 月至 2023 年 6 月期间在中国 3 家中心接受 ICI 联合化疗（ICI 联合化疗组）或单纯化疗（化疗组）的 NSCLC 合并 MPE 患者。比较了两组的临床结局和不良事件（AE）。
结果
共纳入 155 例符合条件的患者，中位年龄为 61.0 岁。男性和从不吸烟者分别占 73.5%和 39.4%。57 例和 98 例患者分别接受了 ICI 联合化疗和化疗。中位研究随访 10.8 个月，ICI 联合化疗组的无进展生存期（PFS）明显长于化疗组（中位 PFS：7.4 个月 vs. 5.7 个月；HR=0.594[95%CI：0.403-0.874]，P=0.008）。两组的总生存期（OS）无差异（ICI 联合化疗组：34.2 个月 vs. 化疗组：28.3 个月；HR=0.746[95%CI：0.420-1.325]，P=0.317）。最常见的 3 级或更高级别的 AE 包括中性粒细胞计数减少（ICI 联合化疗组 3 例[5.3%]，化疗组 5 例[5.1%]）和血红蛋白减少（ICI 联合化疗组 3 例[5.3%]，化疗组 10 例[10.2%]）。
结论
在未经治疗的 NSCLC 合并 MPE 患者中，ICI 联合化疗可显著延长 PFS，且耐受性可管理，但对 OS 的影响可能有限。
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