Shi Chunhui, Liu Xiaochun, Zhao Jing, Xu Wenjiang, Zhang Rui, He Zhongqin
Department of Oncology, Baoji Traditional Chinese Medicine Hospital No. 43 Baofu Road, Jintai District, Baoji 721000, Shaanxi, China.
Am J Transl Res. 2024 Aug 15;16(8):3702-3712. doi: 10.62347/FEVG6730. eCollection 2024.
To assess the efficacy and safety of combining Programmed Death-1/Programmed Death-Ligand 1 (PD-1/L1) inhibitors with platinum-containing chemotherapy for treating late-stage Non-Small Cell Lung Cancer (NSCLC) patients who have developed resistance to Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs).
A retrospective analysis was conducted at Baoji Traditional Chinese Medicine Hospital involving 133 patients with advanced NSCLC who had shown resistance to EGFR-TKIs and were treated from October 2018 to May 2021. The cohort was categorized into two groups: one treated with immune checkpoint inhibitors (ICIs) plus chemotherapy and antiangiogenic agents (ICIs+BCP group), and the other treated with ICIs alone (ICIs group). Baseline data collected included demographic factors, smoking status, PD-L1 Tumor Proportion Score (TPS), EGFR mutation, Eastern Cooperative Oncology Group (ECOG) score, and routine blood markers prior to second-line therapy. Computed Tomography (CT) scans were performed every two treatment courses to evaluate the treatment efficacy.
The ICIs+BCP group exhibited a statistically significant improvement in Overall Survival (OS) compared to the ICIs group (P=0.001). Cox survival analysis uncovered age (P=0.012), PD-L1 TPS expression (P<0.001), treatment regimen (P=0.006), Neutrophil-to-Lymphocyte Ratio (NLR) (P=0.024), and Platelet-to-Lymphocyte Ratio (PLR) (P=0.005) as independent factors influencing OS in patients with advanced NSCLC resistant to primary-line EGFR-TKI therapy. The nomogram model, based on these prognostic factors, exhibited Area Under the Curve (AUC) values of 0.823 and 0.769, indicating its predictive accuracy for 1-year and 2-year survival, respectively.
Combining ICIs with BCP prolongs OS in patients with NSCLC resistant to EGFR-TKIs. This study underscores the importance of personalized treatment plans and biomarker evaluations to improve outcomes in drug-resistant cases.
评估程序性死亡蛋白1/程序性死亡配体1（PD-1/L1）抑制剂与含铂化疗联合应用于对表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）产生耐药的晚期非小细胞肺癌（NSCLC）患者的疗效和安全性。
在宝鸡市中医医院进行回顾性分析，纳入133例对EGFR-TKIs耐药且于2018年10月至2021年5月接受治疗的晚期NSCLC患者。该队列分为两组：一组接受免疫检查点抑制剂（ICIs）联合化疗及抗血管生成药物治疗（ICIs+BCP组），另一组仅接受ICIs治疗（ICIs组）。收集的基线数据包括人口统计学因素、吸烟状况、PD-L1肿瘤比例评分（TPS）、EGFR突变、东部肿瘤协作组（ECOG）评分以及二线治疗前的常规血液指标。每两个治疗疗程进行一次计算机断层扫描（CT）以评估治疗效果。
与ICIs组相比，ICIs+BCP组的总生存期（OS）有统计学显著改善（P=0.001）。Cox生存分析发现年龄（P=0.012）、PD-L1 TPS表达（P<0.001）、治疗方案（P=0.006）、中性粒细胞与淋巴细胞比值（NLR）（P=0.024）和血小板与淋巴细胞比值（PLR）（P=0.005）是影响一线EGFR-TKI治疗耐药的晚期NSCLC患者OS的独立因素。基于这些预后因素的列线图模型的曲线下面积（AUC）值分别为0.823和0.769，表明其对1年和2年生存率的预测准确性。
ICIs与BCP联合应用可延长对EGFR-TKIs耐药的NSCLC患者的OS。本研究强调了个性化治疗方案和生物标志物评估对改善耐药病例治疗结果的重要性。
