Neoadjuvant PD-(L)1 blockade with or without chemotherapy versus chemotherapy alone in mismatch repair-deficient, potentially resectable stage III-IV_A gastric cancer patients: a single-center retrospective study.

IF 2.5 3区医学 Q3 ONCOLOGY World Journal of Surgical Oncology Pub Date : 2024-11-26 DOI:10.1186/s12957-024-03601-4

Xuchen Zhang, Huiyun Wang, Yi Li, Weihua Yan, Yunqing Chen, Shanai Song, Ning Liu, Chuantao Zhang, Zhaojian Niu, Helei Hou

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引用次数: 0

Abstract

Background: Currently, PD-(L)1 blockade-based neoadjuvant treatment has shown promising outcomes in patients with potentially resectable gastric cancer. In this real-world study, we aimed to retrospectively observe the efficacy including tumor response and event-free survival (EFS), and safety of PD-(L)1 blockade-based neoadjuvant treatment versus chemotherapy alone in potentially resectable gastric cancer patients with microsatellite instability-high (MSI-H) or mismatch-repair deficient (dMMR) status.

Methods: We retrospectively collected the clinical data of patients with potentially resectable gastric cancer and MSI-H/dMMR status who received neoadjuvant treatment followed by D2 gastrectomy at the Affiliated Hospital of Qingdao University from January 2019 to June 2023. The outcomes of interest mainly included overall complete response (CR) rates, radiographical and pathological tumor response, treatment-related adverse events (TRAEs), and EFS.

Results: In total, 30 patients were included in the analysis; 23 patients received neoadjuvant PD-(L)1 blockade plus chemotherapy or PD-(L)1 blockade monotherapy, and seven patients received neoadjuvant chemotherapy. In the PD-(L)1 blockade-based treatment group, 7 of 23 patients (30.4%, 95% CI 0.141-0.530) achieved pathological CR (pCR), while three patients with radiographical CR did not undergo surgery. In contrast, 1 of 7 (14.3%) patients in the neoadjuvant chemotherapy group achieved pCR. The overall CR rate was 43.5% (10 of 23, 95% CI 0.239-0.651) in the PD-(L)1 blockade-based treatment group and 14.3% (1 of 7, 95% CI 0.026-0.513) in the chemotherapy group. The neoadjuvant PD-(L)1 blockade-based treatment regimen was mild and well tolerated. By the latest follow-up, median EFS time was not reached in both cohorts.

Conclusion: In potentially resectable gastric cancer patients with MSI-H/dMMR status, PD-(L)1 blockade-based neoadjuvant treatment regimen provided promising clinical benefits and was well tolerated.

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错配修复缺陷、可能切除的III-IVA期胃癌患者新辅助PD-(L)1阻断联合或不联合化疗与单纯化疗的对比：一项单中心回顾性研究。

背景：目前，基于PD-(L)1受体阻断剂的新辅助治疗在潜在可切除胃癌患者中显示出良好的疗效。在这项真实世界研究中，我们旨在回顾性观察微卫星不稳定性高（MSI-H）或错配修复缺陷（dMMR）的潜在可切除胃癌患者接受基于 PD-(L)1 阻断剂的新辅助治疗与单纯化疗的疗效（包括肿瘤反应和无事件生存期（EFS））和安全性：我们回顾性地收集了2019年1月至2023年6月期间在青岛大学附属医院接受新辅助治疗后进行D2胃切除术的潜在可切除胃癌患者的临床数据，这些患者均为微卫星不稳定性高（MSI-H）或错配修复缺陷（dMMR）状态。研究结果主要包括总完全反应率（CR）、肿瘤放射学和病理学反应、治疗相关不良事件（TRAEs）和EFS：共有30名患者纳入分析，其中23名患者接受了新辅助PD-（L）1阻滞剂加化疗或PD-（L）1阻滞剂单药治疗，7名患者接受了新辅助化疗。在 PD-(L)1 阻断治疗组中，23 例患者中有 7 例（30.4%，95% CI 0.141-0.530）达到病理 CR（pCR），3 例达到放射学 CR 的患者没有接受手术。相比之下，新辅助化疗组的 7 名患者中有 1 人（14.3%）获得了病理 CR。基于 PD-(L)1 阻断剂治疗组的总 CR 率为 43.5%（23 例中的 10 例，95% CI 0.239-0.651），化疗组为 14.3%（7 例中的 1 例，95% CI 0.026-0.513）。基于PD-(L)1受体阻断剂的新辅助治疗方案温和且耐受性良好。在最近一次随访中，两组患者均未达到中位生存时间：结论：对于具有 MSI-H/dMMR 状态的潜在可切除胃癌患者，基于 PD-(L)1 阻断剂的新辅助治疗方案具有良好的临床疗效和耐受性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgical Oncology ONCOLOGY-SURGERY

CiteScore

4.70

自引率

15.60%

发文量

362

审稿时长

3 months

期刊介绍： World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics. Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.