Bone Metastases, Skeletal-Related Events, and Survival in Patients With Metastatic Non-Small Cell Lung Cancer Treated With Immune Checkpoint Inhibitors.
Bone Metastases, Skeletal-Related Events, and Survival in Patients With Metastatic Non-Small Cell Lung Cancer Treated With Immune Checkpoint Inhibitors.
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DOI：
10.6004/jnccn.2020.7668
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发表时间：
2021-04-20
期刊：
影响因子：
--
通讯作者：
Owen DH
中科院分区：
文献类型：
--
作者：
Qin A;Zhao S;Miah A;Wei L;Patel S;Johns A;Grogan M;Bertino EM;He K;Shields PG;Kalemkerian GP;Gadgeel SM;Ramnath N;Schneider BJ;Hassan KA;Szerlip N;Chopra Z;Journey S;Waninger J;Spakowicz D;Carbone DP;Presley CJ;Otterson GA;Green MD;Owen DH
骨转移和骨骼相关事件(SRE)是转移性非小细胞肺癌(MNSCLC)患者发病的常见原因。关于使用免疫检查点抑制剂(ICIS)治疗的mNSCLC患者的骨转移和SRE，以及骨修饰剂(BMA)在这种情况下的疗效的数据有限。在这里，我们报告了在多机构队列中接受ICIS治疗的mNSCLC患者的发生率、对生存的影响、骨转移和SRE的危险因素以及BMA的影响。我们对2014年至2017年在两个三级护理中心接受ICIS治疗的mNSCLC患者进行了回顾性研究。采用LOG-RANK检验比较有无骨转移患者的总存活率(OS)。在控制其他混杂因素的情况下，使用Cox回归模型来评估OS与ICI开始时出现骨转移的相关性。我们确定了330名因转移性疾病接受ICIS治疗的患者。患者的中位年龄为63岁，大多数患者接受二线或二线以上治疗(n=259；78%)，最常见的ICI是尼伏单抗(n=211；%)。中位OS为10个月(95%可信区间为8.4~12.0)。在我们的队列中，124名患者(38%)有基线骨转移，43名(13%)在ICI治疗期间或之后发生了SRE。在控制了表现状态、组织学、治疗路线和疾病负担后，骨转移患者的死亡风险更高(风险比，1.57；95%可信区间，1.19-2.08；P=.001)。使用BMA与OS或SRE风险降低无关。在控制了多种临床特征后，在接受ICI治疗的mNSCLC患者中，基线水平的骨转移与较差的预后相关。使用BMA与SRE减少或存活率差异无关。
Bone metastases and skeletal-related events (SREs) are a frequent cause of morbidity in patients with metastatic non–small cell lung cancer (mNSCLC). Data are limited on bone metastases and SREs in patients with mNSCLC treated using immune checkpoint inhibitors (ICIs), and on the efficacy of bone-modifying agents (BMAs) in this setting. Here we report the incidence, impact on survival, risk factors for bone metastases and SREs, and impact of BMAs in patients with mNSCLC treated with ICIs in a multi-institutional cohort. We conducted a retrospective study of patients with mNSCLC treated with ICIs at 2 tertiary care centers from 2014 through 2017. Overall survival (OS) was compared between patients with and without baseline bone metastases using a log-rank test. A Cox regression model was used to evaluate the association between OS and the presence of bone metastases at ICI initiation, controlling for other confounding factors. We identified a cohort of 330 patients who had received ICIs for metastatic disease. Median patient age was 63 years, most patients were treated in the second line or beyond (n=259; 78%), and nivolumab was the most common ICI (n=211; 64%). Median OS was 10 months (95% CI, 8.4–12.0). In our cohort, 124 patients (38%) had baseline bone metastases, and 43 (13%) developed SREs during or after ICI treatment. Patients with bone metastases had a higher hazard of death after controlling for performance status, histology, line of therapy, and disease burden (hazard ratio, 1.57; 95% CI, 1.19–2.08; P=.001). Use of BMAs was not associated with OS or a decreased risk of SREs. Presence of bone metastases at baseline was associated with a worse prognosis for patients with mNSCLC treated with ICI after controlling for multiple clinical characteristics. Use of BMAs was not associated with reduced SREs or a difference in survival.
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影响因子：
4.6
作者：
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通讯作者：
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DOI：
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发表时间：
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影响因子：
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