Zhao Jing, Miao Da, Zhou Jiaqi, Guo Siyu, Tang Yang, Lan Fen, Xia Lixia, Zhang Ting, Huang Jian
Department of Medical Oncology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Key Laboratory of Tumor Microenvironment and Immune Therapy of Zhejiang Province, Cancer Institute, Second Affiliated Hospital, Hangzhou, Zhejiang, China.
Front Oncol. 2024 Oct 8;14:1432954. doi: 10.3389/fonc.2024.1432954. eCollection 2024.
Patients with locally advanced non-small cell lung cancer (LA-NSCLC) usually bear high tumor burden and are not tolerated well to concurrent chemoradiation therapy (CRT) followed by consolidation immunotherapy. We investigated the feasibility of chemoimmunotherapy as induction therapy before CRT for LA-NSCLC.
We retrospectively analyzed data from 91 patients with unresectable stage III NSCLC treated with either induction chemoimmunotherapy or chemotherapy before CRT. Tumor responses, survival statistics, and toxic effects were compared. The dosimetric parameters of the RT protocol were evaluated. The primary endpoint was progression-free survival (PFS). The overall response (ORR), the depth of response (DpR) were accessed at the end of CRT (ORR, DpR) and induction therapy (ORR, DpR).
The median PFS (mPFS) were significantly longer in the chemoimmunotherapy induction group (13.5 months vs. 11.2 months; HR, 0.56; 95% CI, 0.32-0.97; p=0.036). The ORR, median DpR (mDpR) and mDpR were significantly higher in the chemoimmunotherapy induction group (ORR, 84.0% vs. 65.9%, p=0.044; mDpR, 49.5% vs. 39.0%, p = 0.012; mDpR, 38.5% vs. 28.0%, p=0.044). Incidence of treatment-related adverse events (AE) was similar between groups, with myelosuppression being the most common grade ≥ 3 AE. Regarding radiotherapy, adopting a mapping strategy with a 5-8 mm margin for clinical tumor volume resulted in decreased radiation doses to critical organs in the chemoimmunotherapy induction group.
Chemoimmunotherapy induction therapy before CRT improves efficacy with comparable incidence of AEs compared to chemotherapy induction in LA-NSCLC patients. Further studies are warranted to validate these findings.
局部晚期非小细胞肺癌（LA-NSCLC）患者通常肿瘤负荷较高，对同步放化疗（CRT）后巩固免疫治疗耐受性不佳。我们研究了化疗免疫疗法作为LA-NSCLC患者CRT前诱导治疗的可行性。
我们回顾性分析了91例不可切除的III期NSCLC患者的数据，这些患者在CRT前接受了诱导化疗免疫疗法或化疗。比较了肿瘤反应、生存统计数据和毒性作用。评估了放疗方案的剂量学参数。主要终点是无进展生存期（PFS）。在CRT结束时（总缓解率、缓解深度）和诱导治疗结束时（总缓解率、缓解深度）评估总缓解率（ORR）和缓解深度（DpR）。
化疗免疫疗法诱导组的中位PFS（mPFS）显著更长（13.5个月对11.2个月；风险比，0.56；95%置信区间，0.32 - 0.97；p = 0.036）。化疗免疫疗法诱导组的ORR、中位DpR（mDpR）和mDpR显著更高（ORR，84.0%对65.9%，p = 0.044；mDpR，49.5%对39.0%，p = 0.012；mDpR，38.5%对28.0%，p = 0.044）。两组间治疗相关不良事件（AE）的发生率相似，骨髓抑制是最常见的≥3级AE。关于放疗，在化疗免疫疗法诱导组中，采用临床肿瘤体积边缘为5 - 8 mm的映射策略可降低关键器官的辐射剂量。
与LA-NSCLC患者的化疗诱导相比，CRT前的化疗免疫疗法诱导治疗可提高疗效，且不良事件发生率相当。需要进一步研究来验证这些发现。
