Olivares-Hernández Alejandro, Posado-Domínguez Luis, Redondo-González Juan Carlos, Corvo-Félix Laura, Bellido Hernández Lorena, Fonseca-Sánchez Emilio, Del Barco-Morillo Edel
Thoracic Oncology Unit, Department of Medical Oncology, University Hospital of Salamanca (CAUSA), Salamanca, Spain.
Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain.
Transl Lung Cancer Res. 2024 Oct 31;13(10):2649-2659. doi: 10.21037/tlcr-24-513. Epub 2024 Oct 24.
Platinum-based therapies for patients with advanced non-small-cell lung cancer (NSCLC) have classically provided overall survival (OS) rates of six to nine months and objective response rates (ORRs) of 20-30%. Whether prior immunotherapy determines a different response to platinum is currently unknown. This study aimed to analyse the current response characteristics to platinum as a second-line treatment for advanced NSCLC (PD-L1 ≥50%) after first-line immunotherapy.
This retrospective study was conducted at the University Hospital of Salamanca (CAUSA) between 2016 and 2023 with patients who had advanced NSCLC (PD-L1 ≥50%) treated with second-line platinum-based therapies after immunotherapy (without mutations in , or and with Eastern Cooperative Oncology Group (ECOG) ≤1 during the first- and second-line treatments). Survival and response correlation analyses (Kaplan-Meier and log rank tests in SPSS v. 25) were performed. Subsequently, the results were compared with historical cohorts (PubMed, COCHRANE, ScienceDirect, Embase, and the clinical trial registry) who had received platinum-based therapies for advanced NSCLC.
Seventeen patients were analysed (11 male and 6 female). Their median age was 67 years (interquartile range, 50-77 years). Fifteen patients (88.2%) were smokers or former smokers. The patients' main histology was adenocarcinoma (9 patients, 52.9%). All first-line treatments applied pembrolizumab (median dose: 12 cycles). Second-line platinum-based therapy achieved OS of 25 months (95% CI: 7-45 months) and progression-free survival (PFS) of 6 months (95% CI: 2.5-95 months). The ORR was 47.1% [seven patients with a partial response (PR) and one patient with a complete response (CR)]. Of the patients with PRs or CRs, 75% were treated with platinum plus pemetrexed. The one-year survival rate was 58.8%. The historical OS for first-line platinum-based doublets is 7 to 12 months, with PFS of three to five months and an ORR of 17-30%.
The current response to second-line platinum-based therapies for patients with advanced NSCLC after immunotherapy appears to achieve favourable response rates and be an optimal treatment after progression to immunotherapy. Prior immunotherapy appears to enhance these patients' platinum response, though future confirmatory studies are necessary.
对于晚期非小细胞肺癌（NSCLC）患者，传统的铂类疗法的总生存期（OS）通常为6至9个月，客观缓解率（ORR）为20 - 30%。目前尚不清楚先前的免疫疗法是否会导致对铂类有不同的反应。本研究旨在分析一线免疫治疗后，晚期NSCLC（PD - L1≥50%）患者接受铂类作为二线治疗的当前反应特征。
本回顾性研究于2016年至2023年在萨拉曼卡大学医院（CAUSA）进行，研究对象为晚期NSCLC（PD - L1≥50%）患者，这些患者在免疫治疗后接受二线铂类疗法（、或无突变，且一线和二线治疗期间东部肿瘤协作组（ECOG）评分为≤1）。进行生存和反应相关性分析（在SPSS v. 25中进行Kaplan - Meier和对数秩检验）。随后，将结果与接受铂类疗法治疗晚期NSCLC的历史队列（PubMed、COCHRANE、ScienceDirect、Embase和临床试验注册库）进行比较。
分析了17例患者（11例男性和6例女性）。他们的中位年龄为67岁（四分位间距，50 - 77岁）。15例患者（88.2%）为吸烟者或既往吸烟者。患者的主要组织学类型为腺癌（9例患者，52.9%）。所有一线治疗均应用帕博利珠单抗（中位剂量：12个周期）。二线铂类疗法的OS为25个月（95%CI：7 - 45个月），无进展生存期（PFS）为6个月（95%CI：2.5 - 95个月）。ORR为47.1%[7例部分缓解（PR）患者和1例完全缓解（CR）患者]。在PR或CR患者中，75%接受了铂类加培美曲塞治疗。一年生存率为58.8%。一线铂类双联疗法的历史OS为7至12个月，PFS为3至5个月，ORR为17 - 30%。
免疫治疗后晚期NSCLC患者对二线铂类疗法的当前反应似乎达到了良好的缓解率，并且是免疫治疗进展后的最佳治疗方法。先前的免疫治疗似乎增强了这些患者对铂类的反应，不过未来仍需进行验证性研究。
