Risk and survival of patients with non-small cell lung cancer and pre-existing autoimmune disorders receiving immune checkpoint blockade therapy: Survival analysis with inverse probability weighting from a nationwide, multi-institutional, retrospective study (NEJ047)

IF 4.5 2区 医学 Q1 ONCOLOGY
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Abstract

Background

The risk and survival of patients with non-small cell lung cancer (NSCLC) with pre-existing autoimmune disorders (AIDs) receiving immune checkpoint blockade (ICB) therapy have not been clearly established.

Patients and methods

This multi-institutional, retrospective cohort study was conducted in collaboration with 20 centers in Japan.

Results

In total, 229 patients with advanced or recurrent NSCLC and pre-existing AID, with or without ICB treatment from January 2010–February 2020, were included and analyzed. Among 69 patients who received ICB, 2 received two lines of ICBs with a total of 71 ICB treatments; 57 (80.3 %) and 14 (19.7 %) patients received ICB monotherapy and combination therapy, respectively. AID flares were observed in 18 patients (25.4 %, 95 % confidence interval [CI], 15.8–37.1 %) receiving ICB. AID exacerbations were more likely when NSCLC was diagnosed less than 1 year after the AID diagnosis (odds ratio 5.26 [95 % CI, 1.40–21.61]; P = 0.016). Immune-related adverse events were observed in 32 patients (45.1 %, 95 % CI, 33.2–57.3 %); 17 had grade 3 or higher. The safety profile of combination immunotherapy was not significantly different from that of the monotherapy. After inverse probability weighting, the use of ICB prolonged survival (hazard ratio 0.43 [95 % CI, 0.26–0.70]; P = 0.0006).

Conclusions

These findings revealed a novel risk factor for AID flares following ICB treatment, that is the diagnosis of NSCLC within 1 year of AID diagnosis, and showed that ICBs may improve survival in this population. These results support the utilization of ICB in patients with NSCLC and pre-existing AID.

接受免疫检查点阻断疗法的非小细胞肺癌和原有自身免疫性疾病患者的风险和生存率:一项全国性多机构回顾性研究的反概率加权生存分析 (NEJ047)
背景非小细胞肺癌(NSCLC)患者在接受免疫检查点阻断剂(ICB)治疗前已存在自身免疫性疾病(AID),其风险和生存率尚未明确确定。结果共纳入并分析了229例晚期或复发性NSCLC患者,这些患者在2010年1月至2020年2月期间接受或未接受ICB治疗。在接受 ICB 治疗的 69 例患者中,有 2 例患者接受了两线 ICB 治疗,共计 71 次 ICB 治疗;分别有 57 例(80.3%)和 14 例(19.7%)患者接受了 ICB 单药治疗和联合治疗。接受 ICB 治疗的患者中有 18 人(25.4%,95% 置信区间 [CI],15.8%-37.1%)出现 AID 复发。如果NSCLC在AID确诊后不到1年才确诊,则AID加重的可能性更大(几率比5.26 [95 % CI, 1.40-21.61];P = 0.016)。32名患者(45.1%,95% CI,33.2-57.3%)出现了免疫相关不良反应,其中17人的不良反应为3级或3级以上。联合免疫疗法的安全性与单一疗法无明显差异。结论这些研究结果发现了一个新的风险因素,即在确诊AID后1年内诊断出NSCLC,这也是AID复发的风险因素。这些结果支持在患有 NSCLC 并已存在 AID 的患者中使用 ICB。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Lung Cancer
Lung Cancer 医学-呼吸系统
CiteScore
9.40
自引率
3.80%
发文量
407
审稿时长
25 days
期刊介绍: Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.
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