Wei Zihan, Zhou Yu, Pu Xingxiang, Yan Xiang
Department of Thoracic Oncology, Peking University People's Hospital, Beijing 100871, China.
The Second Department of Thoracic Oncology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 400013, China.
Zhongguo Fei Ai Za Zhi. 2024 Sep 20;27(9):674-684. doi: 10.3779/j.issn.1009-3419.2024.101.24.
The proportion of patients carrying driver gene mutations is notably high among individuals with non-small cell lung cancer (NSCLC) in China. However, the current neoadjuvant treatment strategies for these patients lack evident benefits. This study aims to investigate the efficacy and adverse reactions of neoadjuvant immunochemotherapy in patients with driver gene-positive NSCLC, thereby exploring its potential therapeutic value.
A total of 50 patients from two centers were retrospectively collected to compare the efficacy and adverse reactions among driver gene-positive NSCLC patients after different treatments and further explore the response to neoadjuvant immunochemotherapy among different EGFR-sensitive subtypes.
A total of 50 patients from two centers were included in this study. Among the 40 patients from Peking University People's Hospital (PKUPH), 21 received neoadjuvant immunotherapy, with 57.1% showing partial response on imaging. The major pathological response (MPR) rate after neoadjuvant immunochemotherapy was 38.1%, and pathological complete response (pCR) was only observed in this group. No significant differences were noted in adverse events or their impact on surgical difficulty among different treatments. Additionally, 10 patients from Hunan Cancer Hospital (HNCA) were included to analyze the differences in efficiency among EGFR-sensitive subtypes under various neoadjuvant strategies. No significant radiological response differences were observed between neoadjuvant immunotherapy and targeted therapy. However, patients with the L858R mutation exhibited MPR and pCR only after receiving immunotherapy, surpassing targeted therapy outcomes, while no significant differences were found among 19del patients.
Under the premise of not exacerbating adverse effects, neoadjuvant immunochemotherapy achieved superior rates of MPR and pCR, with long-term survival comparable to targeted therapy.
在中国非小细胞肺癌（NSCLC）患者中，携带驱动基因突变的患者比例显著较高。然而，目前针对这些患者的新辅助治疗策略缺乏明显益处。本研究旨在探讨新辅助免疫化疗在驱动基因阳性NSCLC患者中的疗效和不良反应，从而探索其潜在的治疗价值。
回顾性收集来自两个中心的50例患者，比较不同治疗后驱动基因阳性NSCLC患者的疗效和不良反应，并进一步探讨不同EGFR敏感亚型对新辅助免疫化疗的反应。
本研究共纳入来自两个中心的50例患者。在北京大学人民医院（PKUPH）的40例患者中，21例接受了新辅助免疫治疗，影像学上57.1%显示部分缓解。新辅助免疫化疗后的主要病理缓解（MPR）率为38.1%，且仅在该组观察到病理完全缓解（pCR）。不同治疗之间在不良事件或其对手术难度的影响方面未观察到显著差异。此外，纳入了湖南省肿瘤医院（HNCA）的10例患者，以分析不同新辅助策略下EGFR敏感亚型之间的疗效差异。新辅助免疫治疗与靶向治疗之间未观察到显著的放射学反应差异。然而，L858R突变患者仅在接受免疫治疗后出现MPR和pCR，超过了靶向治疗的效果，而19del患者之间未发现显著差异。
在不加重不良反应的前提下，新辅助免疫化疗实现了更高的MPR和pCR率，长期生存率与靶向治疗相当。
