Department of Gynecology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
Cancer Med. 2024 Oct;13(19):e70204. doi: 10.1002/cam4.70204.
Immunotherapy has led to changes in cervical cancer guidelines. Therefore, additional biomarkers to identify the ideal patient who would experience the most benefit may be important.
We retrospectively collected 208 patients with R/M CC and recorded clinicopathologic information, peripheral blood markers and treatments to analyze the prognostic factors of clinical outcomes. Response rate comparison, univariate, and multivariate analyses were performed to assess the efficacy of different factors.
A total of 43.27% patients achieved objective responses, including 18 with complete response and 72 with partial response. Patients receiving first-line immunotherapy had much higher objective response rate (ORR) than the remaining patients (53.8% vs. 34.8%, p = 0.006). CRP >3 ECOG ≥1 and recurrence in 6 months predicted shorter progression free survival (PFS). CRP >3, GLU >6.1 independently predicted unfavorable overall survival (OS). Compared with no antiangiogenic therapy, previous antiangiogenic therapy reduced the median OS by nearly 14 months. Immunotherapy rechallenge was still effective after first immunotherapy failure, and combined with dual-immunotherapy or bevacizumab combined with chemoradiotherapy resulted in a 60.00% or 62.50% ORR, respectively. Patients with squamous cell carcinoma, with stable disease or objective response in the first immunotherapy or without chemotherapy in second immunotherapy had favorable clinical outcome.
The baseline CRP levels in serum was an independent factor for PFS and OS of R/M CC patients treated with immunotherapy, and previous antiangiogenic therapy was associated with poor OS. Patients still show response to immunotherapy rechallenge and combined treatment with bevacizumab or candonilimab showed higher response rate than anti-PD-1 after immunotherapy failure.
免疫疗法改变了宫颈癌治疗指南。因此，寻找额外的生物标志物来识别最有可能受益的理想患者可能很重要。
我们回顾性收集了 208 例 R/M CC 患者的临床病理资料、外周血标志物和治疗情况，分析了临床结局的预后因素。通过反应率比较、单因素和多因素分析评估了不同因素的疗效。
共有 43.27%的患者获得了客观缓解，其中完全缓解 18 例，部分缓解 72 例。接受一线免疫治疗的患者客观缓解率（ORR）明显高于其余患者（53.8%比 34.8%，p=0.006）。CRP>3、ECOG≥1 和 6 个月内复发预测无进展生存期（PFS）较短。CRP>3、GLU>6.1 独立预测总生存期（OS）不良。与无抗血管生成治疗相比，既往抗血管生成治疗使中位 OS 缩短近 14 个月。首次免疫治疗失败后再次进行免疫治疗仍然有效，且联合双免疫治疗或贝伐珠单抗联合放化疗的 ORR 分别为 60.00%和 62.50%。鳞状细胞癌、首次免疫治疗时疾病稳定或客观缓解、或第二次免疫治疗中无化疗的患者临床结局较好。
血清 CRP 水平是 R/M CC 患者接受免疫治疗后 PFS 和 OS 的独立因素，既往抗血管生成治疗与 OS 不良相关。免疫治疗失败后再次进行免疫治疗和联合贝伐珠单抗或卡瑞利珠单抗治疗的患者仍有反应，且反应率高于免疫治疗失败后抗 PD-1 治疗。
