Management of non-small cell lung cancer after 2 years of immunotherapy

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research Pub Date : 2025-03-25 DOI:10.1016/j.resmer.2025.101169

Cédric Mahiat , Jacques Cadranel , Constance Méteyé , Samy Houari , Lise Rosencher , Christelle Epaud , Jérémy Slomka , Vincent Fallet , Anthony Canellas

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Abstract

Background

The optimal management strategy for metastatic or advanced-stage non-small-cell lung cancer (NSCLC) after 2 years of immune checkpoint inhibitor (ICI) remains unclear.

Methods

We conducted a single-center retrospective observational study to characterize the management of patients who received at least 2 years of ICI in the first-line setting for a metastatic or advanced-stage NSCLC.

Results

Among the 254 patients that received ICI in the first-line setting, 39 (15%) achieved 2 years of treatment (ICI in monotherapy, n = 14; ICI with chemotherapy, n = 25). ICI was discontinued after 2 years (<30 months) in 31 (79%) of the cases. During the first 2 years, 29 patients (74%) had no disease progression (2 complete radiological responses, 25 partial radiological responses, and 2 stable diseases) and 10 patients (26%) experienced at least one oligo-progression, which was treated with local ablative treatment (LAT), allowing continuation of ICI up to 2 years. A positron emission tomography (PET) scan was performed at 2 years for 37 patients (95%), revealing a complete metabolic response (CMR) in 16 individuals (43%). None of these patients progressed subsequently (median follow-up: 13 months). After 2 years of ICI, the 12-month progression-free survival was 100% in case of CMR versus 49% (95% CI, 29–91) in the absence of CMR (p = 0.00037).

Conclusions

A CMR at 2 years of ICI is associated with a favorable prognosis. Further studies are needed to better establish the role of PET scan at 2 years, the relevance of LAT and the optimal duration of ICI.

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非小细胞肺癌免疫治疗2年后的处理

背景：在使用免疫检查点抑制剂（ICI）治疗2年后，转移性或晚期非小细胞肺癌（NSCLC）的最佳治疗策略尚不清楚。方法：我们进行了一项单中心回顾性观察性研究，以描述在一线接受至少2年ICI治疗的转移性或晚期NSCLC患者的管理情况。结果254例在一线接受ICI治疗的患者中，39例（15%）达到了2年的治疗(单药治疗的ICI， n = 14；ICI合并化疗，n = 25)。31例（79%）患者在2年（30个月）后停止使用ICI。在最初的2年中，29名患者（74%）没有疾病进展（2名完全放射反应，25名部分放射反应，2名疾病稳定），10名患者（26%）经历了至少一次低进展，这些患者接受了局部消融治疗（LAT），允许持续ICI长达2年。37名患者（95%）在2年后进行了正电子发射断层扫描（PET）扫描，显示16名患者（43%）有完全代谢反应（CMR）。这些患者随后均无进展（中位随访：13个月）。ICI治疗2年后，有CMR的患者12个月无进展生存率为100%，无CMR的患者为49% (95% CI, 29-91) （p = 0.00037）。结论ICI 2年CMR与良好的预后相关。需要进一步的研究来更好地确定2岁时PET扫描的作用、LAT的相关性和ICI的最佳持续时间。

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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