Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Int J Radiat Oncol Biol Phys. 2024 Nov 1;120(3):698-707. doi: 10.1016/j.ijrobp.2024.05.015. Epub 2024 May 24.
This study aimed to evaluate the efficacy of local ablative therapy (LAT) combined with pembrolizumab in patients with synchronous oligometastatic non-small cell lung cancer (NSCLC) and to identify patients who would most benefit from LAT.
We retrospectively identified patients who received diagnosis of synchronous oligometastatic NSCLC (≤5 metastatic lesions and ≤3 organs involved) and were treated with first-line pembrolizumab between January 2017 and December 2022. Patients who underwent LAT, including surgery or radiation therapy at all disease sites, were compared with those who did not undergo LAT. A recursive partitioning analysis (RPA) model was developed using prognostic factors for progression-free survival (PFS).
Among the 258 patients included, 78 received LAT with pembrolizumab, and 180 received pembrolizumab alone. The median follow-up duration was 15.5 months (range, 3.0-71.2 months). In the entire cohort, LAT was independently associated with significantly improved PFS (hazard ratio [HR], 0.64; P = .015) and overall survival (OS) (HR, 0.61; P = .020). In the propensity score-matched cohort (N = 74 in each group), the median PFS was 19.9 months and 9.6 months, respectively (P = .003), and the median OS was 42.2 months and 20.5 months, respectively (P = .045), for the LAT and non-LAT groups. Based on the RPA model, incorporating the number of metastatic lesions, performance status, and programmed cell death-ligand 1 expression level, patients were stratified into 3 risk groups with distinct PFS. LAT significantly improved PFS and OS in the low- and intermediate-risk groups; however, no difference was observed in the high-risk group. LAT was more effective as a consolidative treatment after pembrolizumab initiation than as an upfront therapy.
LAT combined with pembrolizumab was associated with higher PFS and OS compared with pembrolizumab alone in selected patients with synchronous oligometastatic NSCLC. The RPA model could serve as a valuable clinical tool for identifying appropriate patients for LAT.
本研究旨在评估局部消融治疗（LAT）联合 pembrolizumab 治疗同步寡转移性非小细胞肺癌（NSCLC）的疗效，并确定最受益于 LAT 的患者。
我们回顾性地确定了在 2017 年 1 月至 2022 年 12 月期间接受一线 pembrolizumab 治疗且诊断为同步寡转移性 NSCLC（≤5 个转移病灶和≤3 个受累器官）的患者。将接受 LAT（包括所有疾病部位的手术或放射治疗）的患者与未接受 LAT 的患者进行比较。使用无进展生存期（PFS）的预后因素开发递归分区分析（RPA）模型。
在 258 例患者中，78 例接受了 LAT 联合 pembrolizumab 治疗，180 例仅接受了 pembrolizumab 治疗。中位随访时间为 15.5 个月（范围 3.0-71.2 个月）。在整个队列中，LAT 与显著改善的 PFS（风险比 [HR]，0.64；P =.015）和总生存期（OS）（HR，0.61；P =.020）独立相关。在倾向评分匹配队列（每组 N = 74）中，LAT 和非 LAT 组的中位 PFS 分别为 19.9 个月和 9.6 个月（P =.003），中位 OS 分别为 42.2 个月和 20.5 个月（P =.045）。基于 RPA 模型，将转移病灶数量、表现状态和程序性细胞死亡配体 1 表达水平纳入其中，患者被分为具有不同 PFS 的 3 个风险组。LAT 显著改善了低危和中危组的 PFS 和 OS，但高危组无差异。LAT 作为 pembrolizumab 起始后的巩固治疗比作为初始治疗更有效。
与单独使用 pembrolizumab 相比，在选择的同步寡转移性 NSCLC 患者中，LAT 联合 pembrolizumab 治疗可带来更高的 PFS 和 OS。RPA 模型可作为识别适合 LAT 治疗患者的有价值的临床工具。
