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>PD-1/PD-L1 Inhibitor Combined with Chemotherapy Can Improve the Survival of Non-Small Cell Lung Cancer Patients with Brain Metastases
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PD-1/PD-L1 Inhibitor Combined with Chemotherapy Can Improve the Survival of Non-Small Cell Lung Cancer Patients with Brain Metastases
Introduction:Immune checkpoint inhibitor (ICI) monotherapy has limited efficacy in patients with non-small cell lung cancer (NSCLC) and brain metastases (BMs). With the wide use of ICI-based combinations, the efficacy of different ICI combination strategies in patients with NSCLC and BMs needs to be further elucidated.Methods:We retrospectively reviewed 526 patients with non-small cell lung cancer (NSCLC) treated with ICIs from January 2016 to December 2019 in the Shanghai Pulmonary Hospital. Patients with BMs treated with ICIs were further divided into two groups: those with BM prior to the ICI treatment (pBM group), and those with BM after the treatment (aBM group). We assessed intracranial progression-free survival (IPFS), systemic progression-free survival (SPFS), overall survival (OS), intracranial objective response rate (IORR), and intracranial disease control rate (IDCR).Results:We found 77 patients out of 526 with BMs; 69 presented the BMs prior to the ICI treatments and 8 showed BMs after the ICI treatments. In the pBM group, the median IPFS and SPFS were 7.39 months and 5.39 months, respectively. Combination therapy significantly improved both the IPFS (p=0.007) and the SPFS (p=0.007) when compared with monotherapy. Further analysis demonstrated that ICIs combined with chemotherapy significantly improved both the IPFS (p=0.009) and the SPFS (p=0.006) when compared with monotherapy. While ICIs combined with anti-angiogenic therapy improved the SPFS (p=0.005) but not the IPFS (p=0.139). The median OS was 27.43 months for patients in the pBM group. Further analyses suggested that combination treatment also improved the OS when compared with monotherapy (p=0.003). Subgroup analysis results showed that ICIs combined with chemotherapy led to better OS than ICIs monotherapy (p=0.006). Radiotherapy had no significant impact on survival (IPFS p=0.272, OS p=0.142) in the patients of the pBM group.Conclusion:ICIs combined with chemotherapy demonstrated survival benefits over ICI monotherapy in patients with NSCLCs and BMs.? 2020 Sun et al.
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机译：简介：免疫检查点抑制剂（ICI）单疗法对非小细胞肺癌（NSCLC）和脑转移（BMS）的患者有限。随着ICI的广泛使用，需要进一步阐明不同ICI组合策略对NSCLC和BMS患者的疗效。方法：我们回顾性地审查了用ICIS治疗的非小细胞肺癌（NSCLC）的526名患者2016年1月至2019年12月在上海肺医院。用ICIS处理的BMS患者进一步分为两组：在ICI治疗（PBM组）之前BM的那些，治疗后与BM（ABM组）。我们评估了无颅内进展的存活（IPF），全身性进展生存（SPF），整体存活（OS），颅内客观反应率（IORR）和颅内疾病控制率（IDCR）。结果：我们发现77名患者526 of BMS; 69在ICI治疗之前呈现了BMS，8例在ICI治疗后显示了BMS。在PBM组中，中位IPF和SPF分别为7.39个月和5.39个月。与单疗法相比，联合治疗显着改善了IPF（P = 0.007）和SPFS（P = 0.007）。进一步的分析表明，与单疗法相比，ICIS与化疗结合化疗显着改善了IPF（P = 0.009）和SPF（P = 0.006）。虽然ICIS与抗血管生成治疗结合改善SPF（P = 0.005）但不是IPF（P = 0.139）。 PBM组中的患者中位数OS为27.43个月。进一步分析表明，与单疗法相比，组合治疗还改善了OS（p = 0.003）。亚组分析结果表明，ICIS与化疗结合的结果导致更好的OS，而不是ICIS单药治疗（P = 0.006）。放射疗法对PBM组患者的存活（IPFS p = 0.272，OS p = 0.142）没有显着影响。结论：ICIS与化疗相结合，表现出对NSCLC和BMS患者的ICI单疗法的生存益处。 2020 Sun等人。
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