晚期非鳞状非小细胞肺癌诱导治疗后派姆单抗维持与培美曲塞或不培美曲塞的有效性

IF 4.4 2区医学 Q1 ONCOLOGY

Lung Cancer Pub Date : 2025-06-27 DOI:10.1016/j.lungcan.2025.108642

Bas JM Peters , Esmée van Geffen , Doranne Hilarius , Stephan Böhringer , Juliëtte Zwaveling , Esther Dronkers , Cor H van der Leest , Hans JM Smit

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引用次数: 0

摘要

无致癌驱动突变的晚期非鳞状非小细胞肺癌（NSCLC）推荐的一线治疗是培美曲塞/铂和派姆单抗。然而，培美曲塞联合派姆单抗作为维持治疗的额外生存获益仍不清楚。本研究评估培美曲塞使用的变化及其与派姆单抗联合用于维持治疗的有效性。方法采用荷兰药物审计（DMA）和荷兰肺癌审计-肺肿瘤学（DLCA-L）登记处的数据进行回顾性队列研究。所有新诊断为NSCLC的患者，在2017-2024年期间开始派姆单抗和培美曲塞（和铂）治疗，并至少有一个派姆单抗维持治疗处方（有/没有培美曲塞）。对接受派姆单抗单药或派姆单抗联合培美曲塞维持治疗的患者进行比较。采用Kaplan-Meier分析和Cox比例风险模型评估总生存期（OS），并根据人口统计学、ECOG表现状态、PD-L1表达和医院类型进行调整。结果在2333例患者中，548例（23.5%）接受了派姆单抗单药治疗，1785例（76.5%）在维持治疗期间同时接受了派姆单抗和培美曲塞治疗。各医院培美曲塞的使用差异很大。派姆单抗的中位OS为21.0个月（95% CI 18.8-29.2），派姆单抗/培美曲塞的中位OS为18.2个月（95% CI 16.4-19.6），调整后的风险比为0.91 （95% CI 0.78-1.05）。结论：在这个庞大的现实世界队列中，培美曲塞与派姆单抗联合在维持治疗中没有提供额外的生存益处。这些发现对治疗指南建议的在以派姆单抗为基础的方案的维持阶段常规使用培美曲塞提出了质疑。

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The effectiveness of pembrolizumab maintenance with or without pemetrexed after induction treatment for advanced non-squamous Non–Small-Cell Lung cancer

Introduction

The recommended first line treatment for advanced non-squamous non-small cell lung cancer (NSCLC) without oncogenic driver mutations is pemetrexed/platinum and pembrolizumab. However, the added survival benefit of pemetrexed as maintenance treatment when combined with pembrolizumab remains unclear. This study evaluates the variation in pemetrexed use and its effectiveness when combined with pembrolizumab in maintenance therapy.

Methods

A retrospective cohort study was conducted using data from the Dutch Medication Audit (DMA) and the Dutch Lung Cancer Audit – Lung Oncology (DLCA-L) registries. All patients with a new diagnosis of NSCLC who started pembrolizumab and pemetrexed (and platinum) treatment and had at least one prescription of pembrolizumab maintenance (with/without pemetrexed) treatment between 2017–2024 were included. Patients receiving maintenance therapy with pembrolizumab monotherapy or pembrolizumab combined with pemetrexed were compared. Overall survival (OS) was assessed using Kaplan-Meier analysis and Cox proportional hazards models, adjusting for demographics, ECOG performance status, PD-L1 expression, and hospital type.

Results

Among 2333 patients, 548 (23.5%) received pembrolizumab monotherapy, and 1785 (76.5%) received both pembrolizumab and pemetrexed during maintenance therapy. Wide variation in pemetrexed use across hospitals was noted. The median OS was 21.0 months (95% CI 18.8–29.2) for pembrolizumab and 18.2 months (95% CI 16.4–19.6) for pembrolizumab/pemetrexed, with an adjusted hazard ratio of 0.91 (95% CI 0.78–1.05).

Conclusions

In this large real-world cohort, pemetrexed did not provide additional survival benefit in maintenance therapy when combined with pembrolizumab. These findings question the routine use of pemetrexed in the maintenance phase of pembrolizumab-based regimens as suggested by treatment guidelines.

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来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

期刊介绍： Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.