Brown Lauren Julia, Ahn Julie, Gao Bo, Gee Harriet, Nagrial Adnan, Pires da Silva Inês, Hau Eric
Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia.
Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, Australia.
JTO Clin Res Rep. 2024 May 30;5(10):100695. doi: 10.1016/j.jtocrr.2024.100695. eCollection 2024 Oct.
The patterns of oligoprogression after first-line immune checkpoint inhibitors (ICIs) for metastatic NSCLC are yet to be well established. An increasing volume of data suggests that directed radiotherapy improves survival outcomes in patients with progression after ICIs.
A retrospective cohort study was performed on patients with metastatic NSCLC who had completed first-line programmed death-(ligand) 1 inhibitor therapy with or without chemotherapy at two high-volume cancer centers. We sought to characterize the frequency and location of oligoprogression and determine the overall survival (OS) after radiotherapy in this population.
A total of 159 patients were included in the study. At first progression, 62 (39.0%) were classified as undergoing oligoprogression. Multivariate analysis confirmed the presence of brain metastases was associated with an increased likelihood of oligoprogression (OR = 2.44, = 0.04) with most (63.2%) of these patients experiencing progression intracranially. The presence of liver metastases was associated with a decreased likelihood of oligoprogression (OR = 0.17, 0.01). For patients with oligoprogression, those who received radiotherapy had a longer median progression-free survival-2 (PFS2) (17 versus 11.5 mo, HR = 0.51, = 0.02) and a longer median OS (23 versus 13 mo, HR = 0.40, 0.001) compared with those who did not receive radiotherapy. No difference in PFS2 or OS outcomes was observed between patients who received radiotherapy versus those who did not for systemic progression.
In patients with oligoprogressive metastatic NSCLC after treatment with first-line ICIs, radiotherapy significantly improves OS and PFS2 outcomes. Patients with baseline brain metastases are more likely to experience oligoprogression. Further prospective studies in directed, less heterogeneous populations of patients with metastatic NSCLC will be fundamental to optimize management.
一线免疫检查点抑制剂（ICI）用于转移性非小细胞肺癌（NSCLC）后的寡进展模式尚未完全明确。越来越多的数据表明，定向放疗可改善ICI治疗后病情进展患者的生存结局。
对在两个大型癌症中心完成一线程序性死亡-（配体）1抑制剂治疗（联合或不联合化疗）的转移性NSCLC患者进行了一项回顾性队列研究。我们试图描述寡进展的频率和部位，并确定该人群放疗后的总生存期（OS）。
共有159例患者纳入研究。在首次病情进展时，62例（39.0%）被归类为寡进展。多变量分析证实，脑转移的存在与寡进展可能性增加相关（比值比[OR]=2.44，P=0.04），其中大多数（63.2%）患者颅内进展。肝转移的存在与寡进展可能性降低相关（OR=0.17，P=0.01）。对于寡进展患者，与未接受放疗的患者相比，接受放疗的患者无进展生存期-2（PFS2）中位数更长（17个月对11.5个月，风险比[HR]=0.51，P=0.02），OS中位数更长（23个月对13个月，HR=0.40，P<0.001）。对于全身进展的患者，接受放疗与未接受放疗的患者在PFS2或OS结局方面未观察到差异。
在一线ICI治疗后出现寡进展性转移性NSCLC的患者中，放疗可显著改善OS和PFS2结局。基线存在脑转移的患者更有可能出现寡进展。在转移性NSCLC患者更具针对性、异质性较小的人群中开展进一步的前瞻性研究对于优化治疗至关重要。
