A tertiary care cancer center experience with carboplatin and pemetrexed in combination with pembrolizumab in comparison with carboplatin and pemetrexed alone in non-squamous non-small cell lung cancer
A tertiary care cancer center experience with carboplatin and pemetrexed in combination with pembrolizumab in comparison with carboplatin and pemetrexed alone in non-squamous non-small cell lung cancer
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DOI：
10.21037/jtd.2018.06.08
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发表时间：
2018-06-01
影响因子：
2.5
通讯作者：
Shirai, Keisuke
中科院分区：
文献类型：
--
作者：
Afzal, Muhammad Zubair;Dragnev, Konstantin;Shirai, Keisuke
背景：随机II期和III期研究显示，卡铂/培美曲塞联合派姆单抗治疗非鳞状非小细胞肺癌患者的结果令人鼓舞。脑转移患者被排除在II期研究之外。在FDA批准后，我们的机构很早就采用了这种疗法，包括在脑转移患者中使用。我们报告了在单一医疗中心实际使用该方案。方法：这是一项回顾性队列研究，纳入2016年1月1日至2017年12月15日期间诊断并接受卡铂/培美曲塞（a队列）或卡铂/培美曲塞加派姆单抗（B队列）治疗的晚期非鳞状非小细胞肺癌患者。客观缓解率（ORR）为主要终点。无进展生存期（PFS）、疾病控制率（DCR）是次要终点。结果：共纳入54例患者（队列A =37对队列B =17）。队列B的ORR为53.3%，队列A为40.5% （P=0.41）。B组DCR显著高于对照组（86.7% vs. 54%， P=0.02）。队列B的PFS也较高（P= 0.009, HR 0.22）。两组患者发生脑转移的比例相近（A组：32.4%，B组：35.3%，P=0.83）。B组脑转移患者的ORR更高（B组：80% vs. A组：58.3%，P=0.75）。A组患者发生脑转移的比例明显高于B组（91.7% vs. 33.3%， P=0.009）。结论：卡铂、培美曲塞联合派姆单抗在有或无脑转移的非小细胞肺癌患者中显示出有希望的结果，这与II期和III期研究报告的结果一致。在预防进展和实现疾病控制方面观察到最显著的益处。
Background: Randomized phase II and III studies showed the promising results of the combination of carboplatin/pemetrexed with pembrolizumab in non-squamous non-small cell lung cancer patients. Patients with brain metastases were excluded from the phase II study. After FDA approval, this regimen was adopted early at our institution, including a use in patients with brain metastases. We report real-world use of this regimen in a single medical center.Methods: This is a retrospective cohort study that includes patients with advanced non-squamous non-small cell lung cancer diagnosed and treated with carboplatin/pemetrexed (Cohort A) or carboplatin/pemetrexed plus pembrolizumab (Cohort B) between January 1st, 2016 till December 15th, 2017. Objective response rate (ORR) was the primary endpoint. Progression-free survival (PFS), disease control rate (DCR) were the secondary endpoints.Results: A total of 54 patients were included (cohort A =37 vs. cohort B =17). ORR was 53.3% in cohort B vs. 40.5% in cohort A (P=0.41). DCR was significantly higher in cohort B (86.7% vs. 54%, P=0.02). PFS was also higher in cohort B (P= 0.009, HR 0.22). Similar proportion of patients had brain metastases in each cohort (A: 32.4% vs. B: 35.3%, P=0.83). ORR was higher in patients with brain metastases from cohort B (B: 80% vs. A: 58.3%, P=0.75). Significantly higher proportion of the patients with brain metastases progressed in cohort A (A: 91.7% vs. B: 33.3%, P=0.009).Conclusions: The combination of carboplatin and pemetrexed with pembrolizumab showed promising results in a real world setting in patients with NSCLC with and without brain metastases that are in line with the reported results of phase II and III studies. Most significant benefit was observed in preventing progression and achieving the disease control.