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JNCCN:免疫检查点抑制剂治疗的转移性非小细胞肺癌(mNSCLC)患者骨转移、骨相关事件和生存关系

2021-05-11 yd2015 MedSci原创

基线骨转移是免疫检查点抑制剂(ICIs)治疗转移性NSCLC较差的一个预后因素,而骨修复药物(BMAs)的应用并不能改善患者的预后。

约有超过三分之一的转移性非小细胞肺癌(mNSCLC)患者在疾病过程中出现骨转移。骨转移患者中约70%需要阿片类药物止痛治疗。骨转移会导致骨相关事件的发生,比如病理性骨折。很少有研究评估骨转移在免疫检查点抑制剂(ICIs)治疗中的预后价值。有研究提示骨转移对ICIs治疗只有很少的临床响应。但是在ICIs治疗的转移性非小细胞肺癌患者中,骨转移以及骨相关事件(SREs)的发生对其预后的影响不明确。骨修复药物(BMAs),比如常用的唑来膦酸等对骨转移、骨相关事件发生的影响也不明确。

近期,Journal of The National Comprehensive Cancer Network (JNCCN) 杂志发表了一项研究数据,评估ICIs治疗的转移性非小细胞肺癌患者中骨转移、骨相关事件和生存关系。

该研究为回顾性研究,纳入了美国密歇根和俄亥俄州立大学两个肿瘤中心2014至2017年的330例接受ICIs治疗的晚期NSCLC患者,中位年龄为63.4岁,47%为男性,88%为曾或目前在吸烟,66%为腺癌,64%患者接受nivolumab 治疗。其中124 (38%)例患者基线伴有骨转移。伴有或不伴有骨转移患者的临床特征基本平衡。

研究数据显示,总体人群中有43 (13%)例患者出现骨相关不良事件(SREs), 中位时间为2.8个月,病理类型、伴有突变类型、性别和年龄等都不能预测SREs的发生发展。ICIs治疗出现SREs的中位时间为2.3个月。基线伴有骨转移(P<0.001)或ICIs治疗后出现骨转移或骨转移进展(P<0.001)是SREs发生的预测因素。

        ICIs治疗mNSCLC总体人群中骨相关事件(SREs)发生的危险因素

但是,124例基线骨转移患者中分析,年龄、性别、病理类型、突变状态、ECOG评分、PDL1与SREs无明显相关。

      ICIs治疗基线伴有骨转移mNSCLC骨相关事件发生的危险因素

124例基线伴有骨转移患者中,65 (52%)例患者接受BMAs治疗,但是BMAs的使用和SREs的发生无明显相关(P=0.84)。

基线伴有骨转移患者的中位OS为5.9个月 (95% CI, 4.2–7.8),无骨转移患者的中位OS为13.4个月 (95% CI, 10.8–17.0) ,具有显著的统计学差异(P=0.001)。SREs的发生,不管基线骨转移状态,导致较差的OS (7.5个月 vs 10.6 个月; P=0.041)。但是BMAs的使用以及BMAs的类型并不能改善患者的OS。

     ICIs治疗基线伴有骨转移与无骨转移mNSCLC患者的OS

此外,来自密歇根大学的166例转移性NSCLC患者作为仅接受化疗组分析,中位年龄66岁,其中54.2%为男性,85%为曾或目前在吸烟,78.9%为腺癌,最常用的化疗方案为卡铂联合培美曲塞。但是,基线伴有骨转移和无骨转移患者的生存无统计学差异(中位OS, 15.4 vs 12.8个月, P=0.757)。

      只有化疗治疗的基线伴有骨转移与无骨转移mNSCLC患者的OS

综上,基线伴有骨转移是ICIs治疗转移性NSCLC较差的一个预后因素,而BMAs的应用并不能阻止SREs的发生以及改善患者的预后。

原始出处:

Angel Qin, Songzhu Zhao, Abdul Miah, et al. Bone Metastases, Skeletal-Related Events, and Survival in Patients With Metastatic Non–Small Cell Lung Cancer Treated WithImmune Checkpoint Inhibitors. J Natl Compr Canc Netw. 2021 Apr 20;1-7.  doi: 10.6004/jnccn.2020.7668.  Online ahead of print.

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    2021-09-02 jklm09
  4. 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2021, time=2021-05-11, status=1, ipAttribution=)]
  5. 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2021, time=2021-05-11, status=1, ipAttribution=)]
  6. 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2021, time=2021-05-11, status=1, ipAttribution=)]
  7. 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  8. 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    2021-05-11 肿肿

    NSCLC下一步突破在于新靶点了,靶向治疗和免疫治疗基本见顶了,再有新的就需要新机制了

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