Effect of tumor burden and growth rate on treatment outcomes of nivolumab in head and neck cancer
Effect of tumor burden and growth rate on treatment outcomes of nivolumab in head and neck cancer
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DOI：
10.1007/s10147-020-01669-y
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发表时间：
2020-07-01
影响因子：
3.3
通讯作者：
Minami, H.
中科院分区：
文献类型：
--
作者：
Suzuki, C.;Kiyota, N.;Minami, H.
背景 纳武单抗可改善铂类难治性复发性和转移性头颈鳞状细胞癌 (R/M HNSCC) 患者的总生存期 (OS)。然而，在一项研究中，纳武单抗和细胞毒素药物组的 Kaplan-Meier OS 和无进展生存 (PFS) 曲线在 3-6 个月时交叉，表明最初对免疫治疗产生耐药性的患者可能会通过细胞毒素治疗获得更好的结果。在这里，我们探讨了可预测 R/M HNSCC 纳武单抗结果的条件和候选药物。方法 我们回顾性分析了 2014 年至 2018 年连续 27 例接受纳武单抗治疗的 R/M HNSCC 患者的临床记录。肿瘤大小采用 RECIST ver.1.1 进行评估。肿瘤生长率(Gr)定义为3log(D-0/D-pre)/t，其中D(0)和D(pre)是基线和基线前的靶病灶直径(SumTLs)之和，以及t时间，1t定义为4周。结果 25 名患者入组。 3个月内疾病进展的患者的生存率明显较差。治疗前 Gr 较高且基线时 SumTL 较大的患者的结果似乎较差。因此，我们探讨了预后、Gr 和 SumTL 之间的关联。递归分区分析显示，3个月后疾病进展患者的特征为Gr < 0.76和SumTLs < 31.0 mm。此外，Gr < 0.76 和 SumTLs < 31.0 mm 与显着较长的 PFS (p = 0.01) 和 OS (p < 0.01) 相关。结论 这些结果表明，基线时的 Gr 和 SumTL 与接受纳武单抗治疗的 R/M HNSCC 患者的 OS 和 PFS 显着相关。
Background Nivolumab improves overall survival (OS) in patients with platinum-refractory recurrent and metastatic head and neck squamous cell carcinoma (R/M HNSCC). In one study, however, Kaplan-Meier OS and progression-free survival (PFS) curves for the nivolumab and cytotoxic agent arms crossed at 3-6 months, suggesting that patients with initial resistance to immunotherapy might have better outcomes with cytotoxic treatment. Here, we explored the conditions and candidates which are predictive of nivolumab outcomes in R/M HNSCC. Methods We retrospectively reviewed the clinical records of 27 consecutive R/M HNSCC patients treated with nivolumab from 2014 to 2018. Tumor size was evaluated by RECIST ver.1.1. Tumor growth rate (Gr) was defined as 3log(D-0/D-pre)/t, whereD(0)andD(pre)are the sum of the diameters of the target lesions (SumTLs) at baseline and pre-baseline, andtis time, with 1tdefined as 4 weeks. Results Twenty-five patients were enrolled. Survival was significantly worse in patients with disease progression within 3 months. Outcomes appeared poorer in patients with higher pre-treatment Gr and bigger SumTLs at baseline. We therefore explored the association between prognosis, Gr and SumTLs. Recursive partitioning analysis showed that the characteristics of patients with disease progression after 3 months were Gr < 0.76 and SumTLs < 31.0 mm. Further, Gr < 0.76 and SumTLs < 31.0 mm was associated with significantly longer PFS (p = 0.01) and OS (p < 0.01). Conclusions These results suggest that Gr and SumTLs at baseline are significantly associated with OS and PFS in R/M HNSCC patients treated with nivolumab.