Immunotherapy rechallenge after nivolumab treatment in advanced non small cell lung cancer in the real-world setting: A national data base analysis
Immunotherapy rechallenge after nivolumab treatment in advanced non small cell lung cancer in the real-world setting: A national data base analysis
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DOI：
10.1016/j.lungcan.2019.12.017
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发表时间：
2020-02-01
期刊：
影响因子：
5.3
通讯作者：
Chouaid, Christos
中科院分区：
文献类型：
--
作者：
Levra, Matteo Giaj;Cotte, Francois-Emery;Chouaid, Christos
目的：尼伏单抗现在是晚期非小细胞肺癌(NSCLC)患者的参考治疗方法，在之前的铂类化疗失败后。关于停用nivolumab后的治疗方法以及停用nivolumab后进行第二疗程免疫治疗的兴趣的数据很少。这项研究的目的是描述停用nivolumab后的治疗途径，并描述再次接受免疫疗法治疗后的存活率。材料和方法：分析包括2015-2016年间开始使用nivolumab的所有NSCLC患者。如果错过了3次输液，则认为尼伏卢单抗治疗已停止。结果：10,452名患者(71%为男性；平均年龄：63.8+/-9.6岁；鳞状组织学：44%)。Nivolumab治疗的中位持续时间为2.8个月[IQR：1.4-6.9]。中位OS为11.5个月[95%可信区间：11.1-11.9]；5118名(53.4%)患者在接受nivolumab治疗后：其中1517名(29.6%)接受了第二疗程的PD-1抑制剂治疗，要么是在一段时间后(恢复：1127)，要么是在介入化疗后(再挑战：n=390)。恢复组患者停用nivolumab后的中位OS为15.0个月[13.9~16.7个月]，复发组为18.4个月[14.8~21.9]个月。在初始nivolumab治疗持续时间<gt；=3个月的患者中，中位OS显著延长。结论：在这一现实环境中，在nivolumab初始治疗持续时间较长的患者中，在第一疗程nivolumab治疗后再次使用PD-1抑制剂的结果明显更好。
Objectives: Nivolumab is now a reference treatment for patients with advanced non-small cell lung cancer (NSCLC) after failure of prior platinum-based chemotherapy. Little data are available on treatment approaches following discontinuation of nivolumab and on the interest of a second course of immunotherapy after nivolumab discontinuation. The aims of this study were to describe treatment pathways following nivolumab discontinuation and to describe survival following retreatment with immunotherapy.Materials and methods: The analysis includes all patients with NSCLC recorded in a national hospital database, starting nivolumab in 2015-2016. Nivolumab treatment was considered discontinued if >= 3 infusions were missed. Patients starting a second course of PD-1 inhibitor following nivolumab discontinuation were analysed according to the duration of their initial nivolumab treatment course.Results: 10,452 patients were included (71 % men; mean age: 63.8 +/- 9.6 years; squamous histology: 44 %). Median nivolumab treatment duration was 2.8 months [IQR :1.4-6.9]. Median OS was 11.5 months [95 %CI: 11.1-11.9]; 5118 (53.4 %) patients received post nivolumab therapy lines: 1517 (29.6 %) of these received a second course of PD-1 inhibitor, either after a treatment-free interval (resumption: n = 1127) or after intervening chemotherapy (rechallenge: n = 390). Median OS after nivolumab discontinuation was 15.0 months [13.9-16.7) in the resumption group and 18.4 months [14.8-21.9] in the rechallenge group. Median OS was significantly longer in patients with an initial nivolumab treatment duration >= 3 months.Conclusion: In this real-world setting, outcome after retreatment with a PD-1 inhibitor following a first course of nivolumab was significantly better in patients with a longer duration of initial nivolumab treatment.