转移性非小细胞肺癌免疫疗法疗效的预测因素:肺免疫预后指数和免疫相关毒性

IF 2.1 Q3 ONCOLOGY
World Journal of Oncology Pub Date : 2024-04-01 Epub Date: 2024-03-21 DOI:10.14740/wjon1790
Alba Moratiel Pellitero, Maria Zapata Garcia, Marta Gascon Ruiz, Jose Miguel Arbones-Mainar, Rodrigo Lastra Del Prado, Dolores Isla
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引用次数: 0

摘要

背景:免疫检查点抑制剂(ICIs)已被提议作为转移性非小细胞肺癌(NSCLC)的标准一线治疗和后续治疗。本研究分析了肺免疫预后指数(LIPI)良好的患者是否对ICIs有更好的反应,以及临床实践中免疫相关不良事件(irAEs)与反应之间的关系:这是一项观察性、回顾性、单中心研究。研究纳入了2016年至2021年间的IV期NSCLC患者。毒性根据《不良事件通用术语标准》进行评估。反应评估根据RECIST 2.0和免疫相关标准进行。进行了描述性分析和生存分析。评估毒性程度和治疗反应(基于治疗和组织学)。评估了LIPI和反应。LIPI包括dNLR(绝对中性粒细胞计数/(白细胞计数-绝对中性粒细胞计数))≥3和乳酸脱氢酶(LDH)大于正常值上限。患者被分为预后良好组(G)、中等组(I)和预后不良组(P):共纳入 168 名患者(男性 130 人,女性 38 人,平均年龄 64.3 岁)。在一线或二线治疗中使用 ICI 的比例分别为 65% 和 35%。15例(9%)患者出现完全应答(CR),50例(30%)患者出现部分应答(PR),39例(22%)患者病情稳定(SD),45例(28%)患者病情进展(PD),19例(11%)患者未接受评估(NE)。预后良好的 LIPI 患者(dNLR < 3 且 LDH 水平正常)反应较好。无进展生存期(PFS)为:G 19 个月、I 6 个月、P 2 个月;总生存期(OS)为:G 27 个月、I 8 个月、P 3 个月。腺癌患者有116人(77人有G1-4型irAEs(13人CR,31人PR,21人SD,8人PD,4人NE)),无腺癌患者有39人(3人PR,6人SD,21人PD,9人NE)。52例患者患有鳞状细胞癌(27例有irAEs G1-4(2例CR、12例PR、9例SD和4例PD)),25例无irAEs G1-4(4例PR、3例SD、12例PD和6例NE))。IrAEs的出现延长了患者的PFS(19个月 vs. 2个月)和OS(27个月 vs. 4个月;P < 0.0001):结论:LIPI是ICI反应的积极预测因子。结论:LIPI是预测ICI反应的积极指标,irAEs的存在与较好的免疫反应相关。相比之下,无毒性则预示着预后较差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors of Immunotherapy Efficacy in Metastatic Non-Small Cell Lung Cancer: Lung Immune Prognostic Index and Immune-Related Toxicity.

Background: Immune checkpoint inhibitors (ICIs) have been proposed as the standard first-line and subsequent treatment for metastatic non-small cell lung cancer (NSCLC). This study analyzed whether patients with good lung immune prognostic index (LIPI) have a better response to ICIs and the relationship between immune-related adverse events (irAEs) and response in clinical practice.

Methods: This was an observational, retrospective, single-center study. Patients with stage IV NSCLC between 2016 and 2021 were included in the study. Toxicity was assessed according to The Common Terminology Criteria for Adverse Events. Response assessment was performed according to RECIST 2.0 and immuno-related criteria. Descriptive and survival analyses were conducted. Degree of toxicity and response to treatment (based on treatment and histology) were assessed. LIPI and response were assessed. LIPI included dNLR (absolute neutrophil count/(white blood cell count - absolute neutrophil count)) ≥ 3 and lactate dehydrogenase (LDH) greater than the upper limit of normal. Patients were stratified into good (G), intermediate (I), and poor (P) prognostic groups.

Results: A total of 168 patients were included (130 men and 38 women, mean age 64.3 years). ICI use in the first- or second-line treatment was 65% and 35%, respectively. Fifteen (9%) patients showed complete response (CR), 50 (30%) showed partial response (PR), 39 (22%) had stable disease (SD), 45 (28%) had progressive disease (PD), and 19 (11%) were not evaluated (NE). Patients with good prognostic LIPI (dNLR < 3 and normal LDH levels) showed a better response. Progression-free survival (PFS) was 19 months in G, 6 months in I, and 2 months in P. Overall survival (OS) was 27 months in G, 8 months in I, and 3 months in P. One hundred fourteen patients died (56% G, 76% I, 93% P). Patients with adenocarcinoma were 116 (77 with irAEs G1-4 (13 CR, 31 PR, 21 SD, eight PD, and four NE)), and without were 39 (three PR, six SD, 21 PD, and nine NE). Fifty-two patients had squamous carcinoma (27 with irAEs G1-4 (two CR, 12 PR, nine SD, and four PD)), and 25 did not (four PR, three SD, 12 PD, and six NE)). IrAEs appearance was observed in longer PFS (19 vs. 2 months) and OS (27 vs. 4 months; P < 0.0001).

Conclusions: LIPI was a positive predictor of response to ICI. The presence of irAEs is associated with a better immune response. In contrast, the absence of toxicity predicted a worse prognosis.

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来源期刊
CiteScore
6.10
自引率
15.40%
发文量
37
期刊介绍: World Journal of Oncology, bimonthly, publishes original contributions describing basic research and clinical investigation of cancer, on the cellular, molecular, prevention, diagnosis, therapy and prognosis aspects. The submissions can be basic research or clinical investigation oriented. This journal welcomes those submissions focused on the clinical trials of new treatment modalities for cancer, and those submissions focused on molecular or cellular research of the oncology pathogenesis. Case reports submitted for consideration of publication should explore either a novel genomic event/description or a new safety signal from an oncolytic agent. The areas of interested manuscripts are these disciplines: tumor immunology and immunotherapy; cancer molecular pharmacology and chemotherapy; drug sensitivity and resistance; cancer epidemiology; clinical trials; cancer pathology; radiobiology and radiation oncology; solid tumor oncology; hematological malignancies; surgical oncology; pediatric oncology; molecular oncology and cancer genes; gene therapy; cancer endocrinology; cancer metastasis; prevention and diagnosis of cancer; other cancer related subjects. The types of manuscripts accepted are original article, review, editorial, short communication, case report, letter to the editor, book review.
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