Real-world efficacy of PD-1/PD-L1 inhibitors in patients with advanced pulmonary neuroendocrine carcinoma: a single-center analysis.

IF 4.3 2区医学 Q2 ONCOLOGY Therapeutic Advances in Medical Oncology Pub Date : 2024-10-14 eCollection Date: 2024-01-01 DOI:10.1177/17588359241288130

Wanchen Zhai, Ying Yu, Haicheng Wu, Qian Zhang, Yunfei Chen, Yehao Yang, Yun Fan

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Abstract

Background: Immunotherapy blocking programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) has revolutionized the treatment of extensive-stage small-cell lung cancer (SCLC), but only with limited real-world efficacy data; evidence from immunotherapy for other pulmonary neuroendocrine carcinoma (PNEC) is scarce.

Objective: The purpose of this study is to evaluate the efficacy of receiving PD-1/PD-L1 inhibitors in patients with advanced PNEC and explore factors related to survival prognosis, providing clues for treatment for patients with advanced PNEC.

Methods: In all, 203 patients with advanced PNEC who received PD-1/PD-L1 inhibitors between January 2019 and December 2021 were retrospectively analyzed. Kaplan-Meier curves were constructed for progression-free survival (PFS) and overall survival (OS).

Results: For the 203 patients, the objective response rate (ORR) was 48.3%, the disease control rate (DCR) was 83.3%, the median PFS (mPFS) was 6.0 months, and the median OS (mOS) was 13.1 months. Among them, the histology was 166 SCLC, 13 large-cell neuroendocrine carcinoma, and 24 other unspecified PNEC. Histologically, no significant difference was observed in PFS (p = 0.240) or OS (p = 0.845). In first-line (1L) treatment (N = 125), patients received chemoimmunotherapy and had an ORR of 64.8%, DCR of 92.0%, mPFS of 6.6 months, and mOS of 14.9 months. In second-line (2L) or later-line setting, the ORR, DCR, mPFS, and mOS were 21.8%, 69.2%, 4.4, and 9.4 months; immunotherapy plus small-molecule antiangiogenic agents showed significantly greater PFS than immunotherapy monotherapy or chemoimmunotherapy (6.4 vs 1.4 vs 3.7 months, p = 0.041). Patients without liver metastasis had superior PFS (7.0 vs 5.1 months, p < 0.001) and OS (19.2 vs 9.6 months, p < 0.001) than those with liver metastasis.

Conclusion: In clinical practice, PD-1/PD-L1 inhibitors are effective in patients with advanced PNEC, regardless of the pathological histology. The efficacy of 1L immunochemotherapy is worthy of recognition, and the addition of small-molecule antiangiogenic agents to immunotherapy in 2L or later-line treatment provides a better survival trend.

Design: Retrospective study.

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PD-1/PD-L1抑制剂对晚期肺神经内分泌癌患者的实际疗效：单中心分析。

背景：阻断程序性死亡-1（PD-1）/程序性死亡配体-1（PD-L1）的免疫疗法彻底改变了广泛期小细胞肺癌（SCLC）的治疗，但实际疗效数据有限；其他肺神经内分泌癌（PNEC）的免疫疗法证据也很少：本研究旨在评估晚期PNEC患者接受PD-1/PD-L1抑制剂的疗效，并探讨与生存预后相关的因素，为晚期PNEC患者的治疗提供线索：回顾性分析了2019年1月至2021年12月期间接受PD-1/PD-L1抑制剂治疗的203例晚期PNEC患者。构建了无进展生存期（PFS）和总生存期（OS）的卡普兰-梅耶曲线：203例患者的客观反应率（ORR）为48.3%，疾病控制率（DCR）为83.3%，中位PFS（mPFS）为6.0个月，中位OS（mOS）为13.1个月。其中，组织学类型为SCLC的有166例，大细胞神经内分泌癌13例，其他未指定类型的PNEC 24例。从组织学角度看，PFS（P = 0.240）和OS（P = 0.845）无明显差异。在一线（1L）治疗中（N = 125），患者接受化疗免疫疗法，ORR 为 64.8%，DCR 为 92.0%，mPFS 为 6.6 个月，mOS 为 14.9 个月。在二线（2L）或后线治疗中，ORR、DCR、mPFS和mOS分别为21.8%、69.2%、4.4和9.4个月；免疫治疗联合小分子抗血管生成药物的PFS显著高于免疫治疗单药或化学免疫治疗（6.4 vs 1.4 vs 3.7个月，P = 0.041）。没有肝转移的患者的 PFS 更优（7.0 个月 vs 5.1 个月，p p 结论：在临床实践中，无论病理组织学如何，PD-1/PD-L1抑制剂对晚期PNEC患者均有效。1L免疫化疗的疗效值得肯定，在2L或更晚一线治疗中，在免疫治疗的基础上加用小分子抗血管生成药物，可获得更好的生存趋势：设计：回顾性研究。

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来源期刊

Therapeutic Advances in Medical Oncology ONCOLOGY-

CiteScore

8.20

自引率

2.00%

发文量

160

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Medical Oncology is an open access, peer-reviewed journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of cancer. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in medical oncology, providing a forum in print and online for publishing the highest quality articles in this area. This journal is a member of the Committee on Publication Ethics (COPE).