Jin Xuanhong, Pan Yang, Cheng Cheng, Shen Hangchen, Zhai Chongya, Yin Kailai, Zhu Xinyu, Pan Hongming, You Liangkun
Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, China.
Front Pharmacol. 2024 Aug 5;15:1391972. doi: 10.3389/fphar.2024.1391972. eCollection 2024.
In individuals receiving treatment with epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), those exhibiting positive PD-L1 expression might experience reduced progression-free survival (PFS). However, the effects on overall survival (OS) and the determination of efficacious treatment approaches are still not well-defined.
In our retrospective study, we examined data from 193 NSCLC patients with advanced mutations who received first-line TKI treatments, treated at two centers of Shaw Hospital in Zhejiang, China. This analysis covered a period from 1 January 2016 to 30 April 2023.
Patients with PD-L1 positivity exhibited a markedly shorter average PFS (9.5 months versus 17.8 months, < 0.001) and OS (44.4 months versus 65.7 months, = 0.016) relative to those without PD-L1 expression. This difference in both PFS and OS remained statistically significant even after adjusting for multiple factors ( < 0.001 for PFS and = 0.028 for OS). In the PD-L1-positive cohort, introducing combination antiangiogenic significantly extended both PFS (from 9.1 to 25.7 months, = 0.026) and OS (from 42 to 53.5 months, = 0.03). Post-first-line TKI therapy, 39.3% of PD-L1-positive patients and 54.5% of PD-L1-negative patients developed the T790M mutation ( = 0.212), with no notable difference in PFS from second-line TKI treatments between the groups. Additionally, subsequent combination therapy with immunotherapy markedly prolonged OS in the PD-L1-positive group. However, for PD-L1-negative patients, neither combination antiangiogenic therapy nor later-line immunotherapy demonstrated significant benefits in PFS or OS.
For PD-L1-positive patients, combined antiangiogenic treatments and immunotherapy can significantly improve survival outcomes. In contrast, PD-L1-negative patients show less benefit from these therapies, highlighting the greater efficacy of these treatments in PD-L1-positive individuals.
在接受表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）治疗的患者中，那些PD-L1表达呈阳性的患者可能无进展生存期（PFS）缩短。然而，对总生存期（OS）的影响以及有效治疗方法的确定仍未明确。
在我们的回顾性研究中，我们检查了来自中国浙江邵逸夫医院两个中心接受一线TKI治疗的193例晚期非小细胞肺癌（NSCLC）患者的数据。该分析涵盖了2016年1月1日至2023年4月30日的时间段。
与无PD-L1表达的患者相比，PD-L1阳性患者的平均PFS（9.5个月对17.8个月，P<0.001）和OS（44.4个月对65.7个月，P = 0.016）明显更短。即使在调整多个因素后，PFS和OS的这种差异在统计学上仍具有显著性（PFS为P<0.001，OS为P = 0.028）。在PD-L1阳性队列中，引入抗血管生成联合治疗显著延长了PFS（从9.1个月延长至25.7个月，P = 0.026）和OS（从42个月延长至53.5个月，P = 0.03）。一线TKI治疗后，39.3%的PD-L1阳性患者和54.5%的PD-L1阴性患者发生了T790M突变（P = 0.212），两组二线TKI治疗的PFS无显著差异。此外，随后的免疫治疗联合治疗显著延长了PD-L1阳性组的OS。然而，对于PD-L1阴性患者，抗血管生成联合治疗和后线免疫治疗在PFS或OS方面均未显示出显著益处。
对于PD-L1阳性患者，抗血管生成联合治疗和免疫治疗可显著改善生存结局。相比之下，PD-L1阴性患者从这些治疗中获益较少，这突出了这些治疗在PD-L1阳性个体中的更大疗效。
