Nakamura Taiyo, Kawaguchi Yohei, Oosawa Jiyunichirou, Imai Kentaro, Aoki Takuya, Kajiwara Naohiro, Ikeda Norihiko
Department of Thoracic Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, JPN.
Department of Surgery, Tokyo Medical University, Tokyo, JPN.
Cureus. 2025 May 6;17(5):e83610. doi: 10.7759/cureus.83610. eCollection 2025 May.
Background The optimal duration of immune checkpoint inhibitor (ICI) therapy for maximum benefits remains unclear. Recently, the long-term follow-up data from clinical trials suggest the existence of a durable response (DR) that maintains the therapeutic effect even after ICI discontinuation. The study aimed to explore how the characteristics of ICI therapy influence the effectiveness of subsequent treatments in patients with advanced non-small-cell lung cancer (NSCLC). Methods The medical records of 134 patients with NSCLC who received ICIs before December 31, 2022, were retrospectively reviewed. We evaluated the impact of pretreatment ICIs on survival after completion of ICI administration. Results Among the 116 included patients, long ICI use (≥180 days) was the only independent prognostic factor for post-ICI overall survival (OS) in the multivariate analysis (HR: 0.382, 95% CI: 0.206-0.708, =0.002). Patients who received ICIs for < 180 days showed significantly improved survival with subsequent chemotherapy (SC) compared to those who received only best supportive care (BSC) (p<0.001). However, among patients treated with ICIs for ≥ 180 days, no significant difference in OS or post-ICI OS was observed between the SC and BSC groups (p=0.188). In patients who discontinued ICIs due to PD, the impact of ICI treatment duration on survival outcomes differed. Among those with short ICI use, the SC group showed significantly better post-ICI OS compared to the BSC group (p=0.007). However, in patients with long ICI use, there was no significant difference in post-ICI OS between the SC and BSC groups (p=0.913). Regarding OS, no statistically significant differences were observed between the SC and BSC groups, regardless of ICI treatment duration. The 2-year OS was 47.6% in the SC group and 46.0% in the BSC group among patients with short ICI use (p=0.549), and 93.3% vs. 66.7% among those with long ICI use (p=0.136). Similarly, in patients who discontinued ICIs without PD, survival outcomes varied depending on ICI duration. Among those with short ICI use, the BSC group had a 2-year post-ICI OS of 21.1%, which was lower than that of the SC group (50.0%; p=0.08). The 2-year OS was also significantly higher in the SC group (64.3%) compared to the BSC group (31.6%; p=0.008). In contrast, no significant differences were observed in post-ICI OS (p=0.104) or OS (64.3% vs. 31.6%; p=0.104) between the SC and BSC groups among patients with long ICI use. Conclusion The achievement of a DR through prolonged ICI use may reduce the need for immediate subsequent chemotherapy in selected patients.
背景 免疫检查点抑制剂（ICI）治疗的最佳持续时间以实现最大获益仍不明确。最近，临床试验的长期随访数据表明存在持久反应（DR），即即使在ICI停药后仍能维持治疗效果。本研究旨在探讨ICI治疗的特征如何影响晚期非小细胞肺癌（NSCLC）患者后续治疗的有效性。方法 回顾性分析2022年12月31日前接受ICI治疗的134例NSCLC患者的病历。我们评估了ICI预处理对ICI给药完成后生存的影响。结果 在纳入的116例患者中，多因素分析显示长疗程ICI使用（≥180天）是ICI治疗后总生存（OS）的唯一独立预后因素（HR：0.382，95%CI：0.206-0.708，P=0.002）。接受ICI治疗<180天的患者与仅接受最佳支持治疗（BSC）的患者相比，后续化疗（SC）显著改善了生存（P<0.001）。然而，在接受ICI治疗≥180天的患者中，SC组和BSC组之间的OS或ICI治疗后OS无显著差异（P=0.188）。在因疾病进展（PD）而停用ICI的患者中，ICI治疗持续时间对生存结局的影响有所不同。在ICI使用时间短的患者中，SC组的ICI治疗后OS显著优于BSC组（P=0.007）。然而，在ICI使用时间长的患者中，SC组和BSC组之间的ICI治疗后OS无显著差异（P=0.913）。关于OS，无论ICI治疗持续时间如何，SC组和BSC组之间均未观察到统计学显著差异。ICI使用时间短的患者中，SC组的2年OS为47.6%，BSC组为46.0%（P=0.549），ICI使用时间长的患者中分别为93.3%和66.7%（P=0.136）。同样，在未因PD而停用ICI的患者中，生存结局因ICI持续时间而异。在ICI使用时间短的患者中，BSC组的ICI治疗后2年OS为21.1%，低于SC组（50.0%；P=0.08）。SC组的2年OS也显著高于BSC组（64.3%比31.6%；P=0.008）。相比之下，在ICI使用时间长的患者中，SC组和BSC组之间在ICI治疗后OS（P=0.104）或OS（64.3%比31.6%；P=0.104）方面未观察到显著差异。结论 通过延长ICI使用时间实现持久反应可能会减少部分患者对后续立即化疗的需求。
