Fang Yulu, Zhao Yifan, Yu Xiaofu, Liu Shuxun, Tao Gang, Zhong Haijun, Xiang Hai, Yang Yunshan, Shi Zhong
Postgraduate training base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China.
Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China.
J Gastrointest Oncol. 2024 Apr 30;15(2):585-596. doi: 10.21037/jgo-23-814. Epub 2024 Apr 28.
Platinum-based chemotherapy combined with immune checkpoint inhibitors (ICIs) is now becoming the standard first-line therapy for human epidermal growth factor receptor 2 (HER2)-negative advanced gastric cancer (AGC). In China, paclitaxel has shown good efficacy and tolerability in AGC as an alternative for first-line therapy. Combining ICIs with paclitaxel-based chemotherapy may lead to improved tumor immune microenvironment, but evidence in paclitaxel combing with ICIs as first-line regimen is lacking. This multicenter, retrospective research aims to compare effectiveness and tolerability of paclitaxel-based chemotherapy combined with ICIs versus chemotherapy alone as a first-line treatment of HER2-negative AGC in a real-world setting.
Eighty-six patients with HER2-negative AGC were included from 2017 to 2022. Among them, 57 patients received paclitaxel-based chemotherapy plus ICIs, and 29 patients received paclitaxel-based chemotherapy alone. We compared the efficacy and incidence of adverse events between the two therapy options.
Significant improvements in median progression-free survival (PFS) (8.77 versus 7.47 months; P=0.04) and median overall survival (OS) (15.70 versus 14.33 months; P=0.04) were observed in the ICIs combined with paclitaxel-based chemotherapy group. The use of ICIs also significantly prolonged the duration of response (DOR) (7.47 versus 4.59 months; P=0.02). Meanwhile, the ICIs plus chemotherapy group demonstrated significantly improved objective response rate (ORR) (50.9% 27.6%; P=0.03) and disease control rate (DCR) (98.3% 82.8%; P=0.01), and the side effects were tolerable.
In summary, for HER2-negative AGC, ICIs plus paclitaxel-based chemotherapy is effective with mild toxicities, which should be considered as an alternative first-line therapy regimen.
铂类化疗联合免疫检查点抑制剂（ICI）目前正成为人表皮生长因子受体2（HER2）阴性晚期胃癌（AGC）的标准一线治疗方案。在中国，紫杉醇作为一线治疗方案的替代药物，在AGC治疗中已显示出良好的疗效和耐受性。将ICI与基于紫杉醇的化疗联合使用可能会改善肿瘤免疫微环境，但缺乏紫杉醇联合ICI作为一线治疗方案的证据。这项多中心回顾性研究旨在比较在现实环境中，基于紫杉醇的化疗联合ICI与单纯化疗作为HER2阴性AGC一线治疗的有效性和耐受性。
纳入2017年至2022年期间86例HER2阴性AGC患者。其中，57例患者接受基于紫杉醇的化疗加ICI，29例患者仅接受基于紫杉醇的化疗。我们比较了两种治疗方案的疗效和不良事件发生率。
在ICI联合基于紫杉醇的化疗组中，观察到中位无进展生存期（PFS）（8.77个月对7.47个月；P = 0.04）和中位总生存期（OS）（15.70个月对14.33个月；P = 0.04）有显著改善。ICI的使用也显著延长了缓解持续时间（DOR）（7.47个月对4.59个月；P = 0.02）。同时，ICI加化疗组的客观缓解率（ORR）（50.9%对27.6%；P = 0.03）和疾病控制率（DCR）（98.3%对82.8%；P = 0.01）显著提高，且副作用可耐受。
总之，对于HER2阴性AGC，ICI加基于紫杉醇的化疗有效且毒性轻微，应被视为一种替代的一线治疗方案。
