Outcomes of first-line anti-PD-L1 blockades combined with brain radiotherapy for extensive-stage small-cell lung cancer with brain metastasis
Outcomes of first-line anti-PD-L1 blockades combined with brain radiotherapy for extensive-stage small-cell lung cancer with brain metastasis
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DOI：
10.1007/s11060-022-04111-7
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发表时间：
2022-08-17
影响因子：
3.9
通讯作者：
Zhu, Hui
中科院分区：
文献类型：
--
作者：
Ma, Ji;Tian, Yaru;Zhu, Hui
从CASPIAN和IMpower 133试验中，抗程序性细胞死亡配体1（抗PD-L1）阻断剂已成为广泛期小细胞肺癌（ES-SCLC）的一线治疗。小细胞肺癌脑转移（BM）发生率高，脑放疗（BRT）是主要的局部治疗方法，但BRT-免疫治疗方案的数据有限。回顾性研究的目的是研究一线抗PD-L1阻滞剂联合BRT治疗ES-SCLC伴BM的临床疗效和安全性。方法选取2017年至2021年在山东省肿瘤医院和山东省肿瘤科学研究院就诊的ES-SCLC患者。将患者分为抗PD-L1 +BRT组和BRT组。我们还评估了两组的白质脑病。结果共入选46例患者。抗PD-L1 +BRT组15例，BRT组31例。中位总生存期（OS）未达到（NR）vs 15.9 m（P = 0.172）。抗PD-L1阻断剂在数值上延长了无进展生存期（PFS），但未达到显著性（中位数：9.4 m vs 7.4 m，P = 0.362）。中位颅内PFS也未改善（中位数：8.2 m vs 8.9 m，P = 0.620）。两组客观缓解率（ORR）分别为73.33%和77.42%（P = 0.949），疾病控制率（DCR）均为100%。颅内ORR和DCR分别为53.33% vs 70.97%（P = 0.239）和73.33% vs 80.65%（P = 0.855）。两组脑白质病变发生率无显著性差异。结论一线抗PD-L1阻滞剂联合BRT治疗ES-SCLC伴BM患者未获得显著的生存获益，且未增加脑神经毒性。
Introduction Anti-programmed cell death-ligand 1 (Anti-PD-L1) blockades have become the first-line treatment of extensive-stage small-cell lung cancer (ES-SCLC) from CASPIAN and IMpower133 trials. SCLC has a high incidence of brain metastasis (BM) and brain radiotherapy (BRT) is the main local treatment method, but there is limited data on the BRT-immunotherapy scheme. The aim of the retrospective study is to investigate the clinical efficacy and safety of the first-line anti-PD-L1 blockades combined with BRT in ES-SCLC with BM. Methods Patients with newly diagnosed ES-SCLC with baseline BMs at Shandong Cancer Hospital and Research Institute between 2017 and 2021 were selected. Patients were divided into the anti-PD-L1+BRT group and BRT group. We also assessed the leukoencephalopathy in both groups. Results A total of 46 patients were selected. Fifteen were divided into anti-PD-L1+BRT group and 31 to BRT group. The median overall survival (OS) was not reached (NR) vs 15.9 m (P = 0.172). Progression-free survival (PFS) was numerically prolonged with anti-PD-L1 blockades, but the significance was not reached (median: 9.4 m vs 7.4 m, P = 0.362). The median intracranial PFS was not improved, neither (median: 8.2 m vs 8.9 m, P = 0.620). Objective response rate (ORR) in the two groups was 73.33% vs 77.42% (P = 0.949) and disease control rate (DCR) was both 100%. Intracranial ORR and DCR were 53.33% vs 70.97% (P = 0.239) and 73.33% vs 80.65% (P = 0.855), respectively. There was no significant difference in leukoencephalopathy incidence between the two groups. Conclusion The combination of first-line anti-PD-L1 blockades with BRT did not confer a significant survival benefit in ES-SCLC with BM, without enhancing cranial neurotoxicity.