Incidence, Risk Factors, and Effect on Survival of Immune-related Adverse Events in Patients With Non-Small-cell Lung Cancer.
Incidence, Risk Factors, and Effect on Survival of Immune-related Adverse Events in Patients With Non-Small-cell Lung Cancer.
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DOI：
10.1016/j.cllc.2018.08.008
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发表时间：
2018-11
影响因子：
3.6
通讯作者：
Otterson GA
中科院分区：
文献类型：
--
作者：
Owen DH;Wei L;Bertino EM;Edd T;Villalona-Calero MA;He K;Shields PG;Carbone DP;Otterson GA
免疫疗法是非小细胞肺癌的主要治疗方法。发生严重的免疫相关不良事件（irAE）；然而，它们对生存的影响尚不清楚，也没有阐明明确的风险因素。在本研究中，我们在一项具有里程碑意义的分析中发现 irAE 对生存没有显着影响，并且既往接受过放射治疗的患者患肺炎的风险也没有增加。免疫相关不良事件 (irAE) 的危险因素仍未明确。最近，有人提出了 irAE 与临床获益之间的相关性。我们研究了 irAE 的危险因素及其对接受免疫治疗的非小细胞肺癌 (NSCLC) 患者生存的影响。我们对在我们机构接受单药免疫治疗的 NSCLC 患者进行了回顾性评价。 irAE 由治疗医生诊断确定。使用对数秩检验和 Bonferroni 方法在 3 个月时进行了里程碑式的分析。 91 名患者中有 27 名 (30%) 发生了 irAE。患有 irAE 的患者的中位总生存期 (OS) 比未患有 irAE 的患者长（24.3 个月与 5.3 个月；风险比，2.75；95% 置信区间，1.54–4.92；P < .001）。然而，对治疗 3 个月后的患者进行的一项具有里程碑意义的分析显示，患有和不患有 irAE 的患者的 OS 没有差异。尽管这些患者的生存期较短（4.2 个月与 9.7 个月；P = 0.004），但既往接受过胸部放疗的患者并未发现肺炎风险增加。开始免疫治疗后进行放射治疗 (n = 15) 不会增加 irAE 或肺炎的风险；然而，这些患者的 OS 有所改善（17.3 个月与 6.0 个月；P =.016）。在一项具有里程碑意义的分析中，当控制治疗持续时间时，irAE 的发生与生存率没有显着相关。我们发现接受放射治疗的患者患肺炎或 irAE 的风险并未增加。免疫治疗前的放疗与较短的生存期相关，而免疫治疗后的放疗与生存期的改善相关。
Immunotherapy is a mainstay of treatment for nonesmall-cell lung cancer. Serious immune-related adverse events (irAEs) occur; however, their effect on survival is unclear, and no defined risks factors have been elucidated. In the present study, we found no significant effect of irAE on survival in a landmark analysis, and no increased risk of pneumonitis in patients with previous radiation. The risk factors for immune-related adverse events (irAEs) remain undefined. Recently, a correlation between irAEs and clinical benefit was suggested. We examined the risk factors for irAEs and their effect on survival in patients with nonesmall-cell lung cancer (NSCLC) who had received immunotherapy. We performed a retrospective review of patients with NSCLC treated with single-agent immunotherapy at our institution. irAEs were determined by treating physician diagnosis. A landmark analysis was performed at 3 months using log-rank tests and the Bonferroni method. irAEs occurred in 27 of 91 patients (30%). The median overall survival (OS) for patients with irAEs was longer than that for patients without (24.3 vs. 5.3 months; hazard ratio, 2.75; 95% confidence interval, 1.54–4.92; P < .001). However, a landmark analysis of patients after 3 months of treatment revealed no difference in OS between patients with and without irAEs. No increased risk of pneumonitis was seen in patients with previous thoracic radiotherapy, although these patients had shorter survival (4.2 vs. 9.7 months; P =.004). Radiotherapy after the initiation of immunotherapy (n = 15) did not increase the risk of irAEs or pneumonitis; however, these patients had improved OS (17.3 vs. 6.0 months; P =.016). The development of irAEs did not significantly correlate with survival when controlling for the duration of therapy in a landmark analysis. We found no increased risk of pneumonitis or irAEs in patients who had received radiotherapy. Radiotherapy before immunotherapy was associated with shorter survival, and radiotherapy after immunotherapy was associated with improved survival.
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影响因子：
20.4
作者：
Teraoka, Shunsuke;Fujimoto, Daichi;Tomii, Keisuke
通讯作者：
Tomii, Keisuke
影响因子：
4.6
作者：
Fujisawa, Yasuhiro;Yoshino, Koji;Matsushita, Shigeto
通讯作者：
Matsushita, Shigeto
影响因子：
1.6
作者：
Lu, Chieh-Sheng;Liu, Jin-Hwang
通讯作者：
Liu, Jin-Hwang
影响因子：
3.8
作者：
Jafri SH;Shi R;Mills G
通讯作者：
Mills G
影响因子：
2.6
作者：
Ueyama, Tomoko;Arimura, Takeshi;Yoshiura, Takashi
通讯作者：
Yoshiura, Takashi