Efficacy and Safety of Pembrolizumab as Second-Line Treatment for Advanced Non-Small Cell Lung Cancer with Negative Driver Gene After Progression of Platinum-Based Chemotherapy
CHEN Jiajie, et al
Xuzhou Medical University, Jiangsu Xuzhou 221000, China
Abstract：Objective: To study the curative effect and adverse reactions of immune checkpoint inhibitor (ICI) pembrolizumab (pembrolizumab) in the second-line treatment on patients of advanced non-small cell lung cancer (non-small cell lung cancer, NSCLC), and guide its clinical treatment. Methods: The medical records of 7838 patients with advanced NSCLC admitted to our hospital from January 2018 to April 2021 were collected. After standardized screening, the pathological data of 104 patients were finally included, and 104 cases were divided, according to different treatment plans, into study group (n=51) and control group (n=53). The study group was treated with pembrolizumab, and the control group were treated with docetaxel. The objective response rate (ORR), disease control rate (DCR), median progression-free survival (mPFS) and adverse events rate (adverse events rate) of the two groups were compared. Results: Compared with the control group, the DCR (90.2%) of the study group was significantly improved, with statistical difference (χ2=4.803, P=0.028). Compared with the control group, the median PFS (5.2 months) of the study group was significantly longer, but the difference was not statistically significant (χ2=3.560, P=0.059). Compared with the sub group with TPS 1~49%, the median PFS (6.0 months) of the subgroup with TPS≥50% in the study group was significantly longer, with statistical difference (χ2=4.223, P=0.040). In the subgroup for TPS≥50%, the median PFS (6.0 months) of the study group was significantly longer than that of the control group, with statistical difference (χ2=5.207, P=0.023). Compared with the control group, the incidence of immune pneumonia in the study group was higher with statistical difference (χ2=4.630, P=0.031). Conclusion: Pembrolizumab may have better short-term and long-term efficacy in patients with advanced NSCLC who have negative driver genes after the progression of platinum-containing chemotherapy, and for patients with PD-L1 TPS≥50%, pembrolizumab may be more effective, but at the same time attention should be paid to possible immune-related adverse reactions.
陈嘉劼, 朱正秋, 单海霞, 孔飞飞. 帕博利珠单抗二线治疗含铂化疗进展的驱动基因阴性NSCLC的临床研究[J]. 河北医学, 2021, 27(12): 2090-2095.
CHEN Jiajie, et al. Efficacy and Safety of Pembrolizumab as Second-Line Treatment for Advanced Non-Small Cell Lung Cancer with Negative Driver Gene After Progression of Platinum-Based Chemotherapy. HeBei Med, 2021, 27(12): 2090-2095.
[1] Xie Shimin,Wu Zhengguo,Qi Yi et al.The metastasizing mechanisms of lung cancer:recent advances and therapeutic challenges[J] .Biomed Pharmacother,2021,138(1):111450. [2] 代岩,曲伟伟.BIM基因多态性对NSCLC行铂类药物化疗的观察[J].临床肺科杂志,2019,24(1):111~115. [3] Brito ABC,Camandaroba MPG,VCCD Limam, et al,Anti-PD1 versus anti-PD-L1 immunotherapy in first-line therapy for advanced non-small cell lung cancer:a systematic review and meta-analysis[J] .Thorac Cancer,2021,12(8):1058~1066. [4] 梁雪峰,王文辉,安玉姬,等.阿帕替尼联合一线化疗药物治疗驱动基因阴性晚期非鳞非小细胞肺癌临床观察(附3例报告)[J].山东医药,2019,59(24):60~62. [5] Soria JC,Ohe Y,Vansteenkiste J,et al.Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer[J].N Engl Med,2018,378(2):113~125. [6] Park K,Vansteenkiste J,Lee K H et al.Pan-Asian adapted ESMO clinical practice guidelines for the management of patients with locally-advanced unresectable non-small-cell lung cancer:a KSMO-ESMO initiative endorsed by CSCO,ISMPO,JSMO,MOS,SSO and TOS[J] .Ann Oncol,2020,30(1):191~201. [7] Wu Yi-Long,Lu Shun,Cheng Ying et al.Nivolumab versus docetaxel in a predominantly Chinese patient population with previously treated advanced NSCLC:checkMate 078 randomized phase III clinical trial[J] .Thorac Oncol,2019,14:867~875. [8] Rittmeyer Achim,Barlesi Fabrice,Waterkamp Daniel et al.Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK):a phase 3,open-label,multicentre randomised controlled trial[J] .Lancet,2017,389(12):255~265. [9] 姜倩倩,王镭蓉,于壮.驱动基因阴性晚期NSCLC抗血管生成治疗进展[J].实用肿瘤杂志,2020,35(1):25~29. [10] 薛艳峰.化疗联合帕博利珠单抗治疗晚期肺腺癌患者20例观察[J].中国药物与临床,2020,20(8):1335~1337. [11] 葛俊,郑敏,田雨可,等.免疫检测点抑制剂治疗后“超进展”的晚期肺腺癌患者2例及文献复习[J].肿瘤预防与治疗,2020,33(4):346~351. [12] Herbst Roy S,Garon Edward B,Kim Dong-Wan et al.Long-term outcomes and retreatment among patients with previously treated,programmed death-ligand 1-positive,advanced non-small-cell lung cancer in the KEYNOTE-010 study[J] .Clin Oncol,2020,38:1580~1590. [13] Cui Pengfei,Huang Di,Wu Zhaozhen et al.Association of immune-related pneumonitis with the efficacy of PD-1/PD-L1 inhibitors in non-small cell lung cancer[J] .Ther Adv Med Oncol,2020,12:990~991.
2021, Vol. 27 
冀公网安备13080202000786号