Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
Cancer Immunol Immunother. 2024 Sep 9;73(11):227. doi: 10.1007/s00262-024-03821-3.
Immune checkpoint inhibitors (ICIs) are rarely used to treat advanced pancreatic ductal adenocarcinoma (PDAC) due to marginal efficacy.
This study included 92 consecutive patients diagnosed with advanced or recurrent PDAC who received nivolumab-based treatment. Univariate and multivariate analyses were used to identify prognostic factors. A control group of 301 patients with PDAC who achieved disease control with palliative chemotherapy but without ICIs was selected for comparison using propensity score matching (PSM).
The median overall survival (OS) since nivolumab treatment was 15.8 (95% confidence interval [CI], 12.5-19.0), 2.4 (95% CI 1.2-3.6), and 1.1 (95% CI 1.0-1.2) months in patients who received add-on nivolumab after achieving disease control with chemotherapy, in those who received concomitant nivolumab and chemotherapy without prerequisite confirmation of disease control, and in those who received nivolumab without concomitant chemotherapy, respectively (P < 0.001). After PSM, the median overall survival (OS) since initiation of the concomitant chemotherapy that achieved disease control was significantly longer (P = 0.026) in patients who received add-on nivolumab (19.8 months; 95% CI 14.5-25.1) than in those who received chemotherapy alone (13.8 months; 95% CI 10.8-16.9). The immune profiling of the tumors in resected patients revealed higher scores of CD8 T cells to Tregs in patients with add-on nivolumab comparing to those who received chemotherapy alone.
Adding-on nivolumab was associated with improved OS in patients with advanced PDAC who achieved disease control following chemotherapy.
免疫检查点抑制剂（ICIs）由于疗效有限，很少用于治疗晚期胰腺导管腺癌（PDAC）。
本研究纳入了 92 例连续诊断为晚期或复发性 PDAC 并接受纳武利尤单抗治疗的患者。采用单因素和多因素分析确定预后因素。选择了 301 例接受姑息化疗但未使用 ICIs 控制疾病的 PDAC 患者作为对照组，通过倾向评分匹配（PSM）进行比较。
在化疗控制疾病后加用纳武利尤单抗、同时使用纳武利尤单抗和化疗而无需预先确认疾病控制、以及未同时使用化疗的患者中，纳武利尤单抗治疗后中位总生存期（OS）分别为 15.8（95%置信区间[CI]，12.5-19.0）、2.4（95% CI，1.2-3.6）和 1.1（95% CI，1.0-1.2）个月（P<0.001）。PSM 后，在达到疾病控制的同时使用化疗的患者中，加用纳武利尤单抗的中位总生存期（OS）明显更长（P=0.026）（19.8 个月；95% CI 14.5-25.1），而单独使用化疗的患者为 13.8 个月（95% CI 10.8-16.9）。对接受手术的患者的肿瘤免疫分析显示，与单独接受化疗的患者相比，加用纳武利尤单抗的患者肿瘤中 CD8 T 细胞对 Treg 的评分更高。
在化疗控制疾病后加用纳武利尤单抗可改善晚期 PDAC 患者的 OS。
