根据临床和分子特征识别可切除非小细胞肺癌围手术期免疫疗法联合疗法的受益患者:随机临床试验的荟萃分析

Yunchang Meng, Hedong Han, Suhua Zhu, Chuling Li, Huijuan Li, Zhaofeng Wang, Ranpu Wu, Yimin Wang, Qingfeng Zhang, Yanzhuo Gong, Yong Song, Tangfeng Lv, Hongbing Liu
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引用次数: 0

摘要

目的 本研究旨在根据可切除非小细胞肺癌(NSCLC)的临床和分子特征,确定从围手术期免疫疗法联合化疗(IO-CT)中获益更多的患者亚组。方法 对围手术期 IO-CT 的随机对照试验(RCT)进行了检索。结果纳入了涉及五种 IO-CT 方案的六项研究(n = 3003)。与单纯 CT 相比,所有 IO-CT 方案都能显著改善 EFS、OS、MPR 和 pCR,但毒性增加。Toripa-chemo显示了最佳的EFS,nivo-chemo显示了最佳的OS。与PD-L1 <1%的患者相比,PD-L1≥1%的患者的EFS获益更多(HR[危险比]:1.55,95% CI 1.17-2.04)。鳞状 NSCLC 患者的 pCR 和 MPR 获益明显多于非鳞状 NSCLC 患者(pCR:OR [odds ratio] 0.68,95% CI 0.49-0.95;MPR:OR 0.61,95% CI 0.45-0.82)。曾经吸烟者的 pCR 获益明显高于非吸烟者(OR:2.18;95% CI 1.21-3.92)。此外,与≥65岁的患者相比,65岁及以上患者的OS获益明显更高(HR比:0.59;95% CI 0.36-0.95)。结论在可切除的 NSCLC 中,围手术期 IO-CT 比单纯 CT 更有效,但毒性更大。PD-L1≥1%、鳞状 NSCLC、有吸烟史、年龄超过 65 岁且性别为男性的患者可能会从围术期 IO-CT 中获益更多。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Identifying patients who benefit more from perioperative immunotherapy combinations for resectable non-small cell lung cancer based on clinical and molecular characteristics: a meta-analysis of randomized clinical trials

Identifying patients who benefit more from perioperative immunotherapy combinations for resectable non-small cell lung cancer based on clinical and molecular characteristics: a meta-analysis of randomized clinical trials

Purpose

This study aims to identify patient subgroups who benefit more from perioperative immunotherapy combined with chemotherapy (IO-CT) based on clinical and molecular characteristics in resectable non-small cell lung cancer (NSCLC).

Methods

Randomized controlled trials (RCTs) on perioperative IO-CT were searched. Beneficial differences of IO-CT regimens across different patient subgroups were assessed by pooling trial-specific ratios in event-free survival (EFS), overall survival (OS), pathological complete response (pCR), and major pathological response (MPR).

Results

Six studies (n = 3003) involving five IO-CT regimens were included. Compared to CT alone, all IO-CT regimens significantly improved EFS, OS, MPR, and pCR, but increased toxicity. Toripa-chemo showed the best EFS and nivo-chemo showed the best OS. Patients with PD-L1 ≥ 1% had more EFS benefits compared to those with PD-L1 < 1% (HR [hazard ratio]: 1.55, 95% CI 1.17–2.04). Squamous NSCLC patients had significantly more pCR and MPR benefits than non-squamous NSCLC patients (pCR: OR [odds ratio] 0.68, 95% CI 0.49–0.95; MPR: OR 0.61, 95% CI 0.45–0.82). Former smokers had significantly higher pCR benefits than non-smokers (OR: 2.18; 95% CI 1.21–3.92). Additionally, OS benefit was significantly higher in patients < 65 years compared to those ≥ 65 years (HR ratio: 0.59, 95% CI 0.36–0.95). For MPR, males benefited significantly more from IO-CT compared to females (OR: 1.69, 95% CI 1.18–2.42).

Conclusion

Perioperative IO-CT is more effective but more toxic than CT alone in resectable NSCLC. Patients with PD-L1 ≥ 1%, squamous NSCLC, a history of smoking, age < 65 years and male gender may experience greater benefits from perioperative IO-CT.

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