Ji Xiaoyu, Jiang Rongrong, Liu Tao, Provencio Mariano, Lee Sang Chul, Zhan Qiong, Zhou Xinli
Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China.
Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China.
Transl Lung Cancer Res. 2024 Jul 30;13(7):1695-1707. doi: 10.21037/tlcr-24-477. Epub 2024 Jul 18.
Driver gene-positive non-small cell lung cancer (NSCLC) patients are prone to develop leptomeningeal metastasis (LM), leading to an extremely high mortality. The objective of this study was to assess the efficacy and safety of immune checkpoint inhibitors (ICIs) treatments for patients with NSCLC and LM harboring targetable mutations.
We retrospectively collected records of patients with NSCLC harboring targetable mutations and prescribed ICIs following the diagnosis of LM at Huashan Hospital, Fudan University. In addition, we reviewed relevant literature and enrolled patients who met the inclusion criteria. Clinical characteristics were statistically analyzed, and the Kaplan-Meier method and log-rank test were employed to assess the median progression-free survival (mPFS) and median overall survival (mOS).
A total of 37 patients with NSCLC harboring targetable mutations who received ICIs after LM diagnosis were included. The median age of the enrolled patients was 54 years (range, 33-70 years), and 62.2% were female. Following ICI administration, the intracranial objective response rate (iORR) and intracranial disease control rate (iDCR) for all enrolled patients were 18.9% and 62.2%, respectively. The mPFS of all patients was 2.5 months [95% confidence interval (CI): 2.166-2.834 months] and the mOS was 5.8 months (95% CI: 5.087-6.513 months). Both univariate and multivariate analyses revealed a significant increase in mOS or individuals who had previously undergone cranial radiation therapy compared to those who had not. Furthermore, different histology molecular types were found to be potentially associated with survival time.
Some patients with NSCLC harboring targetable gene mutations following LM diagnosis may benefit from ICI treatment with relatively good tolerance. However, further screening of the most suitable patient populations for ICIs is required.
驱动基因阳性的非小细胞肺癌（NSCLC）患者易发生软脑膜转移（LM），导致极高的死亡率。本研究的目的是评估免疫检查点抑制剂（ICI）治疗携带可靶向突变的NSCLC和LM患者的疗效和安全性。
我们回顾性收集了复旦大学附属华山医院诊断为LM后接受ICI治疗的携带可靶向突变的NSCLC患者的记录。此外，我们查阅了相关文献并纳入符合纳入标准的患者。对临床特征进行统计学分析，并采用Kaplan-Meier法和对数秩检验评估中位无进展生存期（mPFS）和中位总生存期（mOS）。
共纳入37例诊断为LM后接受ICI治疗的携带可靶向突变的NSCLC患者。纳入患者的中位年龄为54岁（范围33 - 70岁），女性占62.2%。ICI给药后，所有纳入患者的颅内客观缓解率（iORR）和颅内疾病控制率（iDCR）分别为18.9%和62.2%。所有患者的mPFS为2.5个月[95%置信区间（CI）：2.166 - 2.834个月]，mOS为5.8个月（95%CI：5.087 - 6.513个月）。单因素和多因素分析均显示，与未接受过颅脑放疗的患者相比，接受过颅脑放疗的患者mOS显著延长。此外，发现不同的组织学分子类型可能与生存时间有关。
一些诊断为LM后携带可靶向基因突变的NSCLC患者可能从ICI治疗中获益，且耐受性相对较好。然而，需要进一步筛选最适合ICI治疗的患者群体。
