Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China.
Department of Radiation Oncology, Shandong University Cancer Center, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
Future Oncol. 2024;20(32):2481-2490. doi: 10.1080/14796694.2024.2385290. Epub 2024 Aug 19.
In first/second generation EGFR-TKIs, strong PD-L1 expression contributes to primary resistance, significantly affecting patient prognosis. The relationship between PD-L1 expression levels and third-generation TKIs remains unclear. This study analyzed advanced NSCLC who received third-generation EGFR-TKIs as first-line systemic therapy from March 2019 to June 2022. The EGFR and PD-L1 status of the patients was also assessed. Overall, 150 patients were included in this study. PD-L1 expression was negative (PD-L1 tumor proportion score <1%) in 89 cases, weak (1-49%) in 42 cases, and strong (≥50%) in 19 cases. mPFS for patients with negative, weak and strong PD-L1 expressions was 23.60, 26.12 and 16.60 months, respectively. The mPFS for strong PD-L1 expression was significantly shorter than that for with weak PD-L1 expression but was not associated with negativity. The same conclusions were shown in subgroup analyses of mutation types and TKI kinds. In addition, Relative to PD-L1-negative patients, resistance to TKIs may be associated with early progression for patients with strong PD-L1 expression. PD-L1 expression in tumor cells influenced the clinical outcomes of patients with advanced NSCLC treated with third-generation EGFR-TKIs. Stronger PD-L1 expression in TKIs-treated patients with advanced first-line EGFR-mutated NSCLC was associated with worse PFS.
在第一代和第二代 EGFR-TKIs 中，强 PD-L1 表达导致原发性耐药，显著影响患者预后。PD-L1 表达水平与第三代 TKI 之间的关系尚不清楚。本研究分析了 2019 年 3 月至 2022 年 6 月接受第三代 EGFR-TKI 作为一线系统治疗的晚期 NSCLC 患者。还评估了患者的 EGFR 和 PD-L1 状态。总体而言，本研究纳入了 150 例患者。PD-L1 表达阴性（PD-L1 肿瘤比例评分＜1%）的患者有 89 例，弱表达（1-49%）的患者有 42 例，强表达（≥50%）的患者有 19 例。PD-L1 表达阴性、弱表达和强表达患者的 mPFS 分别为 23.60、26.12 和 16.60 个月。强 PD-L1 表达患者的 mPFS 明显短于弱 PD-L1 表达患者，但与阴性表达无关。突变类型和 TKI 种类的亚组分析也得出了相同的结论。此外，与 PD-L1 阴性患者相比，强 PD-L1 表达的患者可能因对 TKI 的耐药而导致早期进展。肿瘤细胞中的 PD-L1 表达影响接受第三代 EGFR-TKI 治疗的晚期 NSCLC 患者的临床结局。在接受第三代 EGFR-TKI 治疗的晚期一线 EGFR 突变 NSCLC 患者中，PD-L1 表达越强，PFS 越差。
