在程序性死亡受体 1 配体（PD-L1）抑制剂加化疗方案中加入胸部放疗可延迟广泛期小细胞肺癌且无基线脑转移患者的脑转移发生。
Addition of thoracic radiotherapy to a PD-L1 inhibitor plus chemotherapy regimen delays brain metastasis onset in extensive-stage small cell lung cancer patients without baseline brain metastasis.
作者信息
Huang Baiyang, Liu Senyuan, Wang Kaiyue, Zhao Jiarui, Li Min, Wang Xingpeng, Wang Weiqing, Wang Xiaohan, Yu Jinming, Meng Xue, Cai Guoxin
机构信息
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440, Jiyan Road, Jinan, Shandong, 250117, China.
The Affiliated Taian City Central Hospital of Qingdao University, Taian, Shandong, China.
出版信息
Respir Res. 2025 Mar 5;26(1):85. doi: 10.1186/s12931-025-03157-1.
BACKGROUND
With the application of immune checkpoint inhibitors (ICIs) and the discovery of the synergistic effect of radiotherapy and immunotherapy, the intracranial benefit of thoracic radiotherapy (TRT) is receiving signiffcant clinical attention. The purpose of this study was to analyze the cranial benefits of ICIs and TRT in patients with extensive-stage small cell lung cancer (ES-SCLC) without baseline brain metastases (BMs).
MATERIALS AND METHODS
From August 2019 to August 2022, data from patients diagnosed with ES-SCLC without baseline BMs were retroactively recorded. The Kaplan‒Meier method was used to calculate overall survival (OS), progression-free survival (PFS), and brain metastasis-free survival (BMFS), and the differences between the treatment groups were compared with the log-rank test. Risk factors associated with OS were analyzed via the Cox regression model.
RESULTS
A total of 216 patients were included, with a median follow-up of 24.73 months. Among these patients, 137 (63.4%) received first-line ICIs combined with chemotherapy (ChT), including 32 patients treated with anti-programmed death 1 antibody (αPD-1) and 105 patients treated with anti-programmed death-ligand 1 antibody (αPD-L1), and 79 patients (36.6%) received first-line ChT alone. Compared with the ChT-alone group, the ICI + ChT group demonstrated significantly improved PFS (8.07 vs. 6.87 months; p < 0.001) and OS (19.83 vs. 13.80 months; p = 0.001). The addition of ICIs to the ChT regimen did not significantly delay the onset of BMs compared to that with ChT alone (16.93 vs. 12.67 months; p = 0.379). Notably, the addition of TRT to the αPD-L1 + ChT regimen significantly prolonged BMFS compared to that without TRT (20.27 vs. 8.80 months; p = 0.045).
CONCLUSION
In patients with ES-SCLC without baseline BMs, first-line chemoimmunotherapy significantly improves PFS and OS. However, it does not delay intracranial metastasis. The addition of TRT to αPD-L1 + ChT therapy significant delays the development of BMs.
CLINICAL TRIAL NUMBER
Not applicable.
背景
随着免疫检查点抑制剂（ICIs）的应用以及放疗与免疫治疗协同效应的发现，胸部放疗（TRT）的颅内获益受到了临床的高度关注。本研究旨在分析ICIs和TRT对无基线脑转移（BMs）的广泛期小细胞肺癌（ES-SCLC）患者的颅脑获益情况。
材料与方法
回顾性记录2019年8月至2022年8月诊断为无基线BMs的ES-SCLC患者的数据。采用Kaplan-Meier法计算总生存期（OS）、无进展生存期（PFS）和无脑转移生存期（BMFS），并通过对数秩检验比较各治疗组之间的差异。通过Cox回归模型分析与OS相关的危险因素。
结果
共纳入216例患者，中位随访时间为24.73个月。其中，137例（63.4%）接受一线ICIs联合化疗（ChT），包括32例接受抗程序性死亡1抗体（αPD-1）治疗的患者和105例接受抗程序性死亡配体1抗体（αPD-L1）治疗的患者，79例（36.6%）仅接受一线ChT。与单纯ChT组相比，ICI+ChT组的PFS（8.07个月 vs. 6.87个月；p<0.001）和OS（19.83个月 vs. 13.80个月；p=0.001）显著改善。与单纯ChT相比，在ChT方案中添加ICIs并未显著延迟BMs的发生（16.93个月 vs. 12.67个月；p=0.379）。值得注意的是，与未接受TRT相比，在αPD-L1+ChT方案中添加TRT显著延长了BMFS（20.27个月 vs. 8.80个月；p=0.045）。
结论
对于无基线BMs的ES-SCLC患者，一线化疗免疫疗法显著改善PFS和OS。然而，它并不能延迟颅内转移。在αPD-L1+ChT治疗中添加TRT可显著延迟BMs的发生。
临床试验编号
不适用。
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