局部晚期非小细胞肺癌化放疗和Durvalumab巩固治疗进展后后续化疗的实际效果：CRIMSON研究（HOPE-005）的探索性分析

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer Pub Date : 2024-07-25 DOI:10.1016/j.cllc.2024.07.014

Hayato Kawachi , Motohiro Tamiya , Yuko Oya , Go Saito , Yoshihiko Taniguchi , Hirotaka Matsumoto , Yuki Sato , Taiichiro Otsuki , Hidekazu Suzuki , Yasushi Fukuda , Satoshi Tanaka , Yoko Tsukita , Junji Uchida , Yoshihiko Sakata , Yuki Nakatani , Ryota Shibaki , Daisuke Arai , Asuka Okada , Satoshi Hara , Koichi Takayama , Kazumi Nishino

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引用次数: 0

摘要

背景局部晚期非小细胞肺癌（LA-NSCLC）化放疗（CRT）和durvalumab巩固治疗后的最佳后续治疗策略仍然未知。我们旨在确定这一临床人群的最佳后续治疗策略。材料与方法我们回顾性纳入了523例连续接受CRT治疗的LA-NSCLC患者，并分析了CRT和durvalumab巩固治疗进展后的后续治疗结果。结果在接受后续化疗的122例患者中，55%接受了铂类治疗，25%接受了非铂类治疗，20%接受了含免疫检查点抑制剂（ICI）的治疗。在铂类药物组中，durvalumab无进展生存期（Dur-PFS）≥1年的患者的中位后续治疗无进展生存期（SubTx-PFS）明显长于Dur-PFS < 1年的患者（13.2个月 vs. 4.7个月；危险比，0.45；95%置信区间，0.21-0.97；P = .04）。此外，在接受非铂类化疗的患者中，联合使用血管生成抑制剂组的中位SubTx-PFS长于未使用血管生成抑制剂组，但差异无统计学意义。结论在临床实践中，LA-NSCLC患者在接受CRT和德伐卢单抗巩固治疗后，如果病情进展，通常会重新接受铂类化疗。最佳治疗策略可考虑Dur-PFS和血管生成抑制剂的可行性。有必要开展进一步研究，以确定哪些临床生物标志物可帮助识别从 ICI 重新挑战中获益的患者。

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Real-World Outcomes of Subsequent Chemotherapy after Progression Following Chemoradiation and Consolidative Durvalumab Therapy in Locally Advanced Non-small Cell Lung Cancer: An Exploratory Analysis from the CRIMSON Study (HOPE-005)

Background

The optimal subsequent treatment strategy for locally advanced non-small cell lung cancer (LA-NSCLC) after chemoradiotherapy (CRT) and consolidative durvalumab therapy remains unknown. We aimed to determine the optimal subsequent treatment strategy for this clinical population.

Materials and Methods

We retrospectively enrolled 523 consecutive patients with LA-NSCLC treated with CRT and analyzed the treatment outcomes of subsequent therapy after progression following CRT and consolidative durvalumab therapy. Patients who received tyrosine kinase inhibitors as subsequent therapy were excluded.

Results

Out of 122 patients who received subsequent chemotherapy, 55% underwent platinum-based, 25% non-platinum-based, and 20% immune checkpoint inhibitor (ICI)-containing therapies. In the platinum-based group, patients with a durvalumab-progression-free survival (Dur-PFS) ≥ 1 year had a significantly longer median subsequent therapy-PFS (SubTx-PFS) than those with Dur-PFS < 1 year (13.2 months vs. 4.7 months; hazard ratio, 0.45; 95% confidence interval, 0.21–0.97; P = .04). Furthermore, among patients receiving non-platinum-based chemotherapy, the median SubTx-PFS was longer in the combined with angiogenesis inhibitor group than in the without group, although the difference was not statistically significant. No significant difference of SubTx-PFS was observed between the reason for durvalumab discontinuation and the outcomes of ICI-containing therapy.

Conclusion

In clinical practice, platinum-based chemotherapy rechallenge is frequently employed following progression subsequent to CRT and consolidative durvalumab therapy for LA-NSCLC. Optimal treatment strategies may consider Dur-PFS and angiogenesis inhibitor feasibility. Further research is warranted to identify clinical biomarkers that can help identify patients who would benefit from ICI rechallenge.

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来源期刊

Clinical lung cancer 医学-肿瘤学

CiteScore

7.00

自引率

2.80%

发文量

159

审稿时长

24 days

期刊介绍： Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.