Qin Yiwei, Mo You, Li Pengwei, Liang Xinyi, Yu Jinming, Chen Dawei
Department of Radiation Oncology, Cheeloo College of Medicine, Shandong University Cancer Center, Jinan 250012, China.
Department of Shandong Provincial Key Laboratory of Precision Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan 250117, China.
Cancers (Basel). 2025 May 20;17(10):1711. doi: 10.3390/cancers17101711.
BACKGROUND/OBJECTIVES: The PACIFIC trial showed that immune checkpoint inhibitors (ICI) administered after concurrent chemoradiotherapy (cCRT) significantly improve survival in stage III unresectable non-small cell lung cancer (NSCLC). However, the optimal timing of ICI administration with cCRT is still debated, with concerns about increased risks of adverse effects, particularly radiation-induced pneumonitis (RP), from combining radiotherapy and immunotherapy.
A search of multiple databases identified studies on stage III unresectable NSCLC patients receiving cCRT and ICI. A meta-analysis was performed utilizing the meta package in R software. Furthermore, data from 170 patients treated at Shandong Cancer Hospital and Institute between 2019 and 2023 were analyzed to assess RP following cCRT and ICI treatment.
The meta-analysis revealed that the incidences of ≥grade 2 RP were 25.3%, 24.3%, and 45.3% in the ICI following cCRT group, the ICI concurrent with cCRT group, and the ICI prior to cCRT group, respectively. The ICI prior to cCRT group exhibited significantly elevated rates. In the clinical retrospective study, ≥grade 2 RP was more prevalent in the ICI concurrent with cCRT group (HR: 2.258, 95% CI: 1.135-4.492, = 0.020) and the ICI prior to cCRT group (HR: 2.843, 95% CI: 1.453-5.561, = 0.002) compared with the ICI following cCRT group. Furthermore, a shorter interval between treatments correlates with an increased incidence of RP.
Advancing the timing of ICI administration is associated with an increased incidence of ≥grade 2 RP following cCRT in patients with stage III unresectable NSCLC.
背景/目的：PACIFIC试验表明，同步放化疗（cCRT）后给予免疫检查点抑制剂（ICI）可显著提高Ⅲ期不可切除非小细胞肺癌（NSCLC）患者的生存率。然而，ICI与cCRT联合使用的最佳时机仍存在争议，因为担心放疗和免疫治疗联合使用会增加不良反应的风险，尤其是放射性肺炎（RP）。
检索多个数据库，确定接受cCRT和ICI的Ⅲ期不可切除NSCLC患者的研究。使用R软件中的meta包进行荟萃分析。此外，分析了2019年至2023年期间在山东省肿瘤医院和研究所接受治疗的170例患者的数据，以评估cCRT和ICI治疗后的RP情况。
荟萃分析显示，cCRT后ICI组、cCRT同步ICI组和cCRT前ICI组中≥2级RP的发生率分别为25.3%、24.3%和45.3%。cCRT前ICI组的发生率显著升高。在临床回顾性研究中，与cCRT后ICI组相比，cCRT同步ICI组（HR：2.258，95%CI：1.135 - 4.492，P = 0.020）和cCRT前ICI组（HR：2.843，95%CI：1.453 - 5.561，P = 0.002）中≥2级RP更为普遍。此外，治疗间隔时间越短，RP的发生率越高。
对于Ⅲ期不可切除NSCLC患者，提前给予ICI与cCRT后≥2级RP的发生率增加有关。
