{"title":"PD-1/PD-L1抑制剂对晚期肺神经内分泌癌患者的实际疗效：单中心分析。","authors":"Wanchen Zhai, Ying Yu, Haicheng Wu, Qian Zhang, Yunfei Chen, Yehao Yang, Yun Fan","doi":"10.1177/17588359241288130","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Immunotherapy blocking programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) has revolutionized the treatment of extensive-stage small-cell lung cancer (SCLC), but only with limited real-world efficacy data; evidence from immunotherapy for other pulmonary neuroendocrine carcinoma (PNEC) is scarce.</p><p><strong>Objective: </strong>The purpose of this study is to evaluate the efficacy of receiving PD-1/PD-L1 inhibitors in patients with advanced PNEC and explore factors related to survival prognosis, providing clues for treatment for patients with advanced PNEC.</p><p><strong>Methods: </strong>In all, 203 patients with advanced PNEC who received PD-1/PD-L1 inhibitors between January 2019 and December 2021 were retrospectively analyzed. Kaplan-Meier curves were constructed for progression-free survival (PFS) and overall survival (OS).</p><p><strong>Results: </strong>For the 203 patients, the objective response rate (ORR) was 48.3%, the disease control rate (DCR) was 83.3%, the median PFS (mPFS) was 6.0 months, and the median OS (mOS) was 13.1 months. Among them, the histology was 166 SCLC, 13 large-cell neuroendocrine carcinoma, and 24 other unspecified PNEC. Histologically, no significant difference was observed in PFS (<i>p</i> = 0.240) or OS (<i>p</i> = 0.845). In first-line (1L) treatment (<i>N</i> = 125), patients received chemoimmunotherapy and had an ORR of 64.8%, DCR of 92.0%, mPFS of 6.6 months, and mOS of 14.9 months. In second-line (2L) or later-line setting, the ORR, DCR, mPFS, and mOS were 21.8%, 69.2%, 4.4, and 9.4 months; immunotherapy plus small-molecule antiangiogenic agents showed significantly greater PFS than immunotherapy monotherapy or chemoimmunotherapy (6.4 vs 1.4 vs 3.7 months, <i>p</i> = 0.041). Patients without liver metastasis had superior PFS (7.0 vs 5.1 months, <i>p</i> < 0.001) and OS (19.2 vs 9.6 months, <i>p</i> < 0.001) than those with liver metastasis.</p><p><strong>Conclusion: </strong>In clinical practice, PD-1/PD-L1 inhibitors are effective in patients with advanced PNEC, regardless of the pathological histology. The efficacy of 1L immunochemotherapy is worthy of recognition, and the addition of small-molecule antiangiogenic agents to immunotherapy in 2L or later-line treatment provides a better survival trend.</p><p><strong>Design: </strong>Retrospective study.</p>","PeriodicalId":23053,"journal":{"name":"Therapeutic Advances in Medical Oncology","volume":"16 ","pages":"17588359241288130"},"PeriodicalIF":4.3000,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11475206/pdf/","citationCount":"0","resultStr":"{\"title\":\"Real-world efficacy of PD-1/PD-L1 inhibitors in patients with advanced pulmonary neuroendocrine carcinoma: a single-center analysis.\",\"authors\":\"Wanchen Zhai, Ying Yu, Haicheng Wu, Qian Zhang, Yunfei Chen, Yehao Yang, Yun Fan\",\"doi\":\"10.1177/17588359241288130\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Immunotherapy blocking programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) has revolutionized the treatment of extensive-stage small-cell lung cancer (SCLC), but only with limited real-world efficacy data; evidence from immunotherapy for other pulmonary neuroendocrine carcinoma (PNEC) is scarce.</p><p><strong>Objective: </strong>The purpose of this study is to evaluate the efficacy of receiving PD-1/PD-L1 inhibitors in patients with advanced PNEC and explore factors related to survival prognosis, providing clues for treatment for patients with advanced PNEC.</p><p><strong>Methods: </strong>In all, 203 patients with advanced PNEC who received PD-1/PD-L1 inhibitors between January 2019 and December 2021 were retrospectively analyzed. Kaplan-Meier curves were constructed for progression-free survival (PFS) and overall survival (OS).</p><p><strong>Results: </strong>For the 203 patients, the objective response rate (ORR) was 48.3%, the disease control rate (DCR) was 83.3%, the median PFS (mPFS) was 6.0 months, and the median OS (mOS) was 13.1 months. Among them, the histology was 166 SCLC, 13 large-cell neuroendocrine carcinoma, and 24 other unspecified PNEC. Histologically, no significant difference was observed in PFS (<i>p</i> = 0.240) or OS (<i>p</i> = 0.845). In first-line (1L) treatment (<i>N</i> = 125), patients received chemoimmunotherapy and had an ORR of 64.8%, DCR of 92.0%, mPFS of 6.6 months, and mOS of 14.9 months. In second-line (2L) or later-line setting, the ORR, DCR, mPFS, and mOS were 21.8%, 69.2%, 4.4, and 9.4 months; immunotherapy plus small-molecule antiangiogenic agents showed significantly greater PFS than immunotherapy monotherapy or chemoimmunotherapy (6.4 vs 1.4 vs 3.7 months, <i>p</i> = 0.041). Patients without liver metastasis had superior PFS (7.0 vs 5.1 months, <i>p</i> < 0.001) and OS (19.2 vs 9.6 months, <i>p</i> < 0.001) than those with liver metastasis.</p><p><strong>Conclusion: </strong>In clinical practice, PD-1/PD-L1 inhibitors are effective in patients with advanced PNEC, regardless of the pathological histology. The efficacy of 1L immunochemotherapy is worthy of recognition, and the addition of small-molecule antiangiogenic agents to immunotherapy in 2L or later-line treatment provides a better survival trend.</p><p><strong>Design: </strong>Retrospective study.</p>\",\"PeriodicalId\":23053,\"journal\":{\"name\":\"Therapeutic Advances in Medical Oncology\",\"volume\":\"16 \",\"pages\":\"17588359241288130\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-10-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11475206/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutic Advances in Medical Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/17588359241288130\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Medical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17588359241288130","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：阻断程序性死亡-1（PD-1）/程序性死亡配体-1（PD-L1）的免疫疗法彻底改变了广泛期小细胞肺癌（SCLC）的治疗，但实际疗效数据有限；其他肺神经内分泌癌（PNEC）的免疫疗法证据也很少：本研究旨在评估晚期PNEC患者接受PD-1/PD-L1抑制剂的疗效，并探讨与生存预后相关的因素，为晚期PNEC患者的治疗提供线索：回顾性分析了2019年1月至2021年12月期间接受PD-1/PD-L1抑制剂治疗的203例晚期PNEC患者。构建了无进展生存期（PFS）和总生存期（OS）的卡普兰-梅耶曲线：203例患者的客观反应率（ORR）为48.3%，疾病控制率（DCR）为83.3%，中位PFS（mPFS）为6.0个月，中位OS（mOS）为13.1个月。其中，组织学类型为SCLC的有166例，大细胞神经内分泌癌13例，其他未指定类型的PNEC 24例。从组织学角度看，PFS（P = 0.240）和OS（P = 0.845）无明显差异。在一线（1L）治疗中（N = 125），患者接受化疗免疫疗法，ORR 为 64.8%，DCR 为 92.0%，mPFS 为 6.6 个月，mOS 为 14.9 个月。在二线（2L）或后线治疗中，ORR、DCR、mPFS和mOS分别为21.8%、69.2%、4.4和9.4个月；免疫治疗联合小分子抗血管生成药物的PFS显著高于免疫治疗单药或化学免疫治疗（6.4 vs 1.4 vs 3.7个月，P = 0.041）。没有肝转移的患者的 PFS 更优（7.0 个月 vs 5.1 个月，p p 结论：在临床实践中，无论病理组织学如何，PD-1/PD-L1抑制剂对晚期PNEC患者均有效。1L免疫化疗的疗效值得肯定，在2L或更晚一线治疗中，在免疫治疗的基础上加用小分子抗血管生成药物，可获得更好的生存趋势：设计：回顾性研究。
Real-world efficacy of PD-1/PD-L1 inhibitors in patients with advanced pulmonary neuroendocrine carcinoma: a single-center analysis.
Background: Immunotherapy blocking programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) has revolutionized the treatment of extensive-stage small-cell lung cancer (SCLC), but only with limited real-world efficacy data; evidence from immunotherapy for other pulmonary neuroendocrine carcinoma (PNEC) is scarce.
Objective: The purpose of this study is to evaluate the efficacy of receiving PD-1/PD-L1 inhibitors in patients with advanced PNEC and explore factors related to survival prognosis, providing clues for treatment for patients with advanced PNEC.
Methods: In all, 203 patients with advanced PNEC who received PD-1/PD-L1 inhibitors between January 2019 and December 2021 were retrospectively analyzed. Kaplan-Meier curves were constructed for progression-free survival (PFS) and overall survival (OS).
Results: For the 203 patients, the objective response rate (ORR) was 48.3%, the disease control rate (DCR) was 83.3%, the median PFS (mPFS) was 6.0 months, and the median OS (mOS) was 13.1 months. Among them, the histology was 166 SCLC, 13 large-cell neuroendocrine carcinoma, and 24 other unspecified PNEC. Histologically, no significant difference was observed in PFS (p = 0.240) or OS (p = 0.845). In first-line (1L) treatment (N = 125), patients received chemoimmunotherapy and had an ORR of 64.8%, DCR of 92.0%, mPFS of 6.6 months, and mOS of 14.9 months. In second-line (2L) or later-line setting, the ORR, DCR, mPFS, and mOS were 21.8%, 69.2%, 4.4, and 9.4 months; immunotherapy plus small-molecule antiangiogenic agents showed significantly greater PFS than immunotherapy monotherapy or chemoimmunotherapy (6.4 vs 1.4 vs 3.7 months, p = 0.041). Patients without liver metastasis had superior PFS (7.0 vs 5.1 months, p < 0.001) and OS (19.2 vs 9.6 months, p < 0.001) than those with liver metastasis.
Conclusion: In clinical practice, PD-1/PD-L1 inhibitors are effective in patients with advanced PNEC, regardless of the pathological histology. The efficacy of 1L immunochemotherapy is worthy of recognition, and the addition of small-molecule antiangiogenic agents to immunotherapy in 2L or later-line treatment provides a better survival trend.
期刊介绍：
Therapeutic Advances in Medical Oncology is an open access, peer-reviewed journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of cancer. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in medical oncology, providing a forum in print and online for publishing the highest quality articles in this area. This journal is a member of the Committee on Publication Ethics (COPE).
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