阿替利珠单抗联合贝伐单抗、卡铂和紫杉醇治疗晚期非鳞状非小细胞肺癌合并恶性胸腔积液患者的疗效
Utility of atezolizumab plus bevacizumab, carboplatin, and paclitaxel combination for the treatment of advanced non-squamous non-small cell lung cancer patients with malignant pleural effusion.
作者信息
Hisakane Kakeru, Atsumi Kenichiro, Seike Masahiro, Hirose Takashi
机构信息
Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan.
Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
出版信息
Transl Lung Cancer Res. 2024 Sep 30;13(9):2106-2115. doi: 10.21037/tlcr-24-347. Epub 2024 Sep 6.
BACKGROUND
Malignant pleural effusion (MPE) remains a negative prognostic factor in non-small cell lung cancer (NSCLC), even after the emergence of immune checkpoint inhibitors. Vascular endothelial growth factor (VEGF) plays a pivotal role in the pathogenesis of MPE. Bevacizumab, a humanized monoclonal antibody against VEGF, is a key agent for patients who develop MPE. However, it is unclear whether MPE is a poor prognostic factor in patients with advanced non-squamous NSCLC receiving treatment with the atezolizumab plus bevacizumab, carboplatin, and paclitaxel (ABCP) regimen. Moreover, the effect of ABCP on MPE control is unknown. This study aimed to elucidate the efficacy and safety of ABCP for non-squamous NSCLC patients with MPE.
METHODS
We retrospectively analyzed consecutive patients with advanced non-squamous NSCLC who received treatment with ABCP (January 2019-September 2023). Patients were divided into two groups (non-MPE and MPE), and treatment outcomes were compared. In the MPE group, treatment efficacy for MPE control and toxicity were evaluated.
RESULTS
Of the 46 patients enrolled, 17 and 29 were included in the non-MPE and MPE groups, respectively. The objective response and disease control rates were not significantly different between the non-MPE and MPE groups (76.5% 51.7%, P=0.13; 88.2% 82.8%, P>0.99; respectively). Similarly, the median progression-free survival and median overall survival were not significantly different (9.9 10.1 months, P=0.87; 16.0 19.9 months, P=0.87, respectively). In the MPE group, 25 patients (86.2%) achieved MPE control lasting >8 weeks from the initiation of treatment with ABCP; the median progression-free survival without an unequivocal increase in MPE was 15.0 months. The incidence rates of grade ≥3 non-immune- and immune-related adverse events were 83% and 17%, respectively. There was no treatment-related death.
CONCLUSIONS
The ABCP regimen may be a promising treatment option for non-squamous NSCLC patients with MPE.
背景
即使在免疫检查点抑制剂出现之后，恶性胸腔积液（MPE）仍是非小细胞肺癌（NSCLC）的不良预后因素。血管内皮生长因子（VEGF）在MPE的发病机制中起关键作用。贝伐单抗是一种抗VEGF的人源化单克隆抗体，是发生MPE患者的关键治疗药物。然而，对于接受阿特珠单抗联合贝伐单抗、卡铂和紫杉醇（ABCP）方案治疗的晚期非鳞状NSCLC患者，MPE是否为不良预后因素尚不清楚。此外，ABCP对MPE控制的效果也未知。本研究旨在阐明ABCP方案治疗非鳞状NSCLC合并MPE患者的疗效和安全性。
方法
我们回顾性分析了连续接受ABCP方案治疗（2019年1月至2023年9月）的晚期非鳞状NSCLC患者。将患者分为两组（非MPE组和MPE组），并比较治疗结果。在MPE组中，评估MPE控制的治疗疗效和毒性。
结果
在纳入的46例患者中，非MPE组和MPE组分别有17例和29例。非MPE组和MPE组的客观缓解率和疾病控制率无显著差异（分别为76.5%对51.7%，P = 0.13；88.2%对82.8%，P>0.99）。同样，中位无进展生存期和中位总生存期也无显著差异（分别为9.9个月对10.1个月，P = 0.87；16.0个月对19.9个月，P = 0.87）。在MPE组中，25例患者（86.2%）自开始ABCP治疗后MPE控制持续>8周；无明确MPE增加的中位无进展生存期为15.0个月。≥3级非免疫相关和免疫相关不良事件的发生率分别为83%和17%。无治疗相关死亡。
结论
ABCP方案可能是治疗非鳞状NSCLC合并MPE患者的一种有前景的治疗选择。
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