Analysis of the Abscopal Effect With Anti-PD1 Therapy in Patients With Metastatic Solid Tumors
Analysis of the Abscopal Effect With Anti-PD1 Therapy in Patients With Metastatic Solid Tumors
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DOI：
10.1097/cji.0000000000000141
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发表时间：
2016-11-01
影响因子：
3.9
通讯作者：
Buzaid, Antonio C.
中科院分区：
文献类型：
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作者：
Gomes, Jessica Ribeiro;Schmerling, Rafael A.;Buzaid, Antonio C.
远位效应是一种罕见的现象，其特征是局部治疗（如放疗）后未经治疗的转移性病变的肿瘤消退。我们研究了抗程序性死亡细胞1（PD 1）治疗进展后放射治疗与抗PD 1治疗相关的远位效应的可能性。本研究是对巴西Antonio Ermirio de Moraes肿瘤中心接受nivolumab或pembrolizumab治疗黑色素瘤、非小细胞肺癌（NSCLC）和肾癌的患者进行的回顾性分析。为了符合这项分析的条件，患者必须有明确的证据表明，在抗PD 1治疗和后续放疗的任何肿瘤部位的疾病进展，同时仍接受抗PD 1。远位效应的特征是放射治疗加抗PD 1后照射野外的反应。对16例患者进行了评价，包括12例转移性黑色素瘤、2例转移性NSCLC和2例转移性肾细胞癌。抗PD 1治疗后至疾病进展的中位时间为3个月。放疗野包括肺、淋巴结和骨，中位总剂量为24戈伊（1-40戈伊），通常分3次（1-10次）。3例黑色素瘤患者发生了远位效应，发生率为18.7%（黑色素瘤患者中为25%）。值得注意的是，其中1例获得了持续> 6个月的显著完全缓解。三名黑色素瘤患者在放疗后获得了显着的局部反应，尽管在远处转移没有反应。11例患者在放疗后出现疾病进展。未观察到毒性增加。总之，NSCLC或肾癌患者均未显示出远位效应，但25%的黑色素瘤患者在抗PD 1单药治疗进展的肿瘤部位接受放疗后继续抗PD 1治疗时，未接受放疗的病变消退。
Abscopal effect is a rare phenomenon characterized by tumor regression of untreated metastatic lesions after a local therapy (eg, radiotherapy). We studied the probability of abscopal effect with radiotherapy associated with anti-programmed death cell 1 (PD1) therapy after progression on anti-PD1. This study is a retrospective analysis of patients treated with nivolumab or pembrolizumab for melanoma, non small cell lung cancer (NSCLC) and renal cancer at Antonio Ermirio de Moraes Oncology Center, Brazil. To be eligible for this analysis, patients must have had unequivocal evidence of disease progression on anti-PD1 therapy and subsequent radiotherapy for any tumor site while still receiving anti-PD1. The abscopal effect was characterized as a response outside the irradiated field after radiotherapy plus anti-PD1. Sixteen patients were evaluated, including 12 metastatic melanoma, 2 metastatic NSCLC, and 2 metastatic renal cell carcinoma. The median time to disease progression on anti-PD1 was 3 months. The radiotherapy field included lung, lymph nodes, and bones, with a median total dose of 24 Gy (1-40 Gy), usually in 3 fractions (1-10 fractions). Three patients with melanoma developed an abscopal effect at a rate of 18.7% (25% among melanoma patients). Of note, one of them achieved a remarkable complete response lasting > 6 months. Three patients with melanoma obtained a significant local response after radiotherapy, despite no response in distant metastases. Eleven patients presented disease progression after radiotherapy. No increased toxicity was observed. In conclusion, no patients with NSCLC or renal cancer showed abscopal effect, but 25% of patients with melanoma showed regression of non irradiated lesions when anti-PD1 was continued after radiation to a tumor site that had progressed on anti-PD1 monotherapy.