放疗可提高免疫治疗寡进展后 NSCLC 患者的生存率：队列研究

IF 3 Q2 ONCOLOGY

JTO Clinical and Research Reports Pub Date : 2024-10-01 DOI:10.1016/j.jtocrr.2024.100695

Lauren Julia Brown M.B.B.S., MClinTRes, FRACP , Julie Ahn M.B.B.S. , Bo Gao BMedSci M.B.B.S., FRACP, PhD , Harriet Gee M.B.B.S., DPhil, FRANZCR , Adnan Nagrial M.B.B.S., FRACP, PhD , Inês Pires da Silva MD, FRACP, PhD , Eric Hau BSc (Med), M.B.B.S., Grad Cert (Biostat), FRANZCR, PhD

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引用次数: 0

摘要

导言一线免疫检查点抑制剂（ICIs）治疗转移性NSCLC后的寡进展模式尚未完全确定。越来越多的数据表明，定向放疗可改善 ICIs 治疗后病情进展患者的生存预后。方法：我们在两家大型癌症中心对已完成一线程序性死亡（配体）1 抑制剂治疗并接受或不接受化疗的转移性 NSCLC 患者进行了一项回顾性队列研究。我们试图描述寡进展的频率和位置，并确定该人群放疗后的总生存率（OS）。在首次进展时，62 例（39.0%）患者被归类为寡进展。多变量分析证实，脑转移与寡进展的可能性增加有关（OR = 2.44，P = 0.04），这些患者中的大多数（63.2%）在颅内出现进展。肝转移的存在与寡进展的可能性降低有关（OR = 0.17，p = 0.01）。对于寡进展患者，与未接受放疗者相比，接受放疗者的中位无进展生存期-2（PFS2）更长（17个月对11.5个月，HR = 0.51，p = 0.02），中位OS（23个月对13个月，HR = 0.40，p <0.001）更长。结论在接受一线 ICIs 治疗后的寡进展转移性 NSCLC 患者中，放疗可显著改善 OS 和 PFS2。基线脑转移的患者更容易出现寡进展。在定向的、异质性较低的转移性 NSCLC 患者群体中开展进一步的前瞻性研究将是优化治疗的基础。

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Radiotherapy Improves Survival in NSCLC After Oligoprogression on Immunotherapy: A Cohort Study

Introduction

The patterns of oligoprogression after first-line immune checkpoint inhibitors (ICIs) for metastatic NSCLC are yet to be well established. An increasing volume of data suggests that directed radiotherapy improves survival outcomes in patients with progression after ICIs.

Methods

A retrospective cohort study was performed on patients with metastatic NSCLC who had completed first-line programmed death-(ligand) 1 inhibitor therapy with or without chemotherapy at two high-volume cancer centers. We sought to characterize the frequency and location of oligoprogression and determine the overall survival (OS) after radiotherapy in this population.

Results

A total of 159 patients were included in the study. At first progression, 62 (39.0%) were classified as undergoing oligoprogression. Multivariate analysis confirmed the presence of brain metastases was associated with an increased likelihood of oligoprogression (OR = 2.44, p = 0.04) with most (63.2%) of these patients experiencing progression intracranially. The presence of liver metastases was associated with a decreased likelihood of oligoprogression (OR = 0.17, p < 0.01). For patients with oligoprogression, those who received radiotherapy had a longer median progression-free survival-2 (PFS2) (17 versus 11.5 mo, HR = 0.51, p = 0.02) and a longer median OS (23 versus 13 mo, HR = 0.40, p < 0.001) compared with those who did not receive radiotherapy. No difference in PFS2 or OS outcomes was observed between patients who received radiotherapy versus those who did not for systemic progression.

Conclusions

In patients with oligoprogressive metastatic NSCLC after treatment with first-line ICIs, radiotherapy significantly improves OS and PFS2 outcomes. Patients with baseline brain metastases are more likely to experience oligoprogression. Further prospective studies in directed, less heterogeneous populations of patients with metastatic NSCLC will be fundamental to optimize management.

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