Prior or concurrent radiotherapy and nivolumab immunotherapy in non-small cell lung cancer
Prior or concurrent radiotherapy and nivolumab immunotherapy in non-small cell lung cancer
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DOI：
10.1111/ajco.13242
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发表时间：
2019-11-12
影响因子：
1.9
通讯作者：
Chua, Benjamin
中科院分区：
文献类型：
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作者：
Ratnayake, Gishan;Shanker, Mihir;Chua, Benjamin
研究表明，放射治疗（RT）联合程序性细胞死亡蛋白1 （PD-1）阻断可引起协同抗肿瘤反应。我们的目的是评估先前或同时的RT是否与接受纳武单抗治疗的转移性非小细胞肺癌（NSCLC）患者的疾病控制改善相关。方法：我们对接受纳武单抗作为转移性NSCLC二线或后续治疗的患者进行了回顾性研究。患者被分为在纳武单抗治疗之前或期间接受过任何非小细胞肺癌放疗的患者和没有非小细胞肺癌放疗史的患者。结果2015年7月至2016年12月，共有85例患者接受了纳武单抗治疗，随访时间中位数为15个月。65名患者（76.4%）在纳武单抗之前或期间接受了RT治疗，20名患者（23.6%）单独接受纳武单抗治疗。两组患者的年龄、运动状态、组织学、吸烟状况和既往治疗的基线特征相似。先前或同时接受RT治疗与较好的PFS相关，接受RT治疗的中位时间为2.8个月，未接受RT治疗的中位时间为1.3个月(风险比(HR) = 0.494；95%置信区间（CI）， 0.279-0.873；P = 0.02)。接受RT治疗组的中位OS为6.4个月，而未接受RT治疗组的中位OS为4.2个月（P = 0.20）。RT与毒性增加无关。结论：与纳武单抗单独治疗相比，在纳武单抗治疗转移性NSCLC之前或同时进行RT治疗与PFS的适度改善相关，没有证据表明不良反应增加。RT可能增强抗pd -1免疫治疗在非小细胞肺癌中的作用。
Background Studies suggest that combining radiotherapy (RT) with programmed cell death protein 1 (PD-1) blockade may elicit a synergistic antitumor response. We aimed to assess whether prior or concurrent RT was associated with improved disease control in patients with metastatic non-small cell lung cancer (NSCLC) treated with nivolumab. Methods We conducted a retrospective study of patients receiving nivolumab as second or subsequent line therapy for metastatic NSCLC. Patients were categorized into those who received any RT for NSCLC prior to or during nivolumab therapy, and those with no history of RT for NSCLC. Results A total of 85 patients received nivolumab between July 2015 and December 2016 and were followed up for a median of 15 months. Sixty-five patients (76.4%) received RT prior to or during nivolumab and 20 patients (23.6%) received nivolumab alone. Baseline characteristics of age, performance status, histology, smoking status and previous therapy were similar between the two groups. Prior or concurrent RT was associated with a superior PFS, median 2.8 months with RT versus 1.3 months without RT (Hazard Ratio (HR) = 0.494; 95% Confidence Interval (CI), 0.279-0.873; P = 0.02). The median OS of the group receiving RT was 6.4 months versus 4.2 months for the no RT group (P = 0.20). RT was not associated with an increase in toxicity. Conclusion RT prior to or concurrent with nivolumab for metastatic NSCLC was associated with a modest improvement in PFS over nivolumab alone with no evidence of increase in adverse effects. RT may potentiate the effect of anti-PD-1 immunotherapy in NSCLC.