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Organ-specific efficacy in advanced non-small cell lung cancer patients treated with first-line single-agent immune
Jiayi Deng1,2, Ming Gao2,3, Qing Gou2
1School of Medicine, South China University of Technology, Guangzhou, Guangdong 511400, China.
Background:
Response to immune checkpoint inhibitors (ICIs) is affected by multiple factors. This study aimed to explore whether sites of metastasis are associated with clinical outcomes of ICIs in advanced non-small-cell lung cancer (NSCLC) patients.
Methods:
The data of NSCLC patients with high programmed death-ligand 1 expression and good performance status receiving first-line ICIs monotherapy from Guangdong Provincial People's Hospital between May 2019 and July 2020 were retrospectively analyzed. Metastatic sites included liver, bone, brain, adrenal gland, pleura, and contralateral lung. Progression-free survival (PFS) and overall survival (OS) were compared between different metastatic sites and metastatic burden by the Kaplan-Meier method. Organ-specific disease control rate (OSDCR) of different individual metastatic sites was evaluated.
Results:
Forty NSCLC patients meeting the criteria were identified. The presence of liver metastasis was significantly associated with shorter PFS (3.1 vs . 15.5 months, P = 0.0005) and OS (11.1 months vs . not reached, P = 0.0016). Besides, patients with bone metastasis tend to get shorter PFS (4.2 vs . 15.5 months, P = 0.0532) rather than OS ( P = 0.6086). Moreover, the application of local treatment could numerically prolong PFS in patients with brain metastasis (15.5 vs . 4.3 months, P = 0.1894). More metastatic organs involved were associated with inferior PFS ( P = 0.0052) but not OS ( P = 0.0791). The presence of liver metastasis or bone metastasis was associated with more metastatic organs (Phi[ϕ]: 0.516, P = 0.001). The highest OSDCR was observed in lung (15/17), and the lowest in the liver (1/4).
Conclusions:
Metastases in different anatomical locations may be associated with different clinical outcomes and local tumor response to ICIs in NSCLC. ICIs monotherapy shows limited efficacy in patients with liver and bone metastasis, thus patients with this type of metastasis might require more aggressive combination strategies.
Insights
Metastatic site impacts immune checkpoint inhibitor (ICI) effectiveness in non-small-cell lung cancer (NSCLC). Liver metastasis significantly worsens outcomes, suggesting combination therapies for these patients.
Area of Science:
- Oncology
- Immunotherapy
- Cancer Metastasis
Background:
- Immune checkpoint inhibitors (ICIs) are crucial in treating advanced non-small-cell lung cancer (NSCLC).
- Patient response to ICIs is influenced by various factors, including metastatic site.
- Understanding the impact of metastasis location on ICI efficacy is vital for optimizing treatment strategies.
Purpose of the Study:
- To investigate the association between metastatic sites and clinical outcomes in advanced NSCLC patients receiving first-line ICIs.
- To evaluate the impact of metastatic burden on progression-free survival (PFS) and overall survival (OS).
- To assess organ-specific disease control rates (OSDCR) for different metastatic locations.
Main Methods:
- Retrospective analysis of 40 advanced NSCLC patients with high PD-L1 expression receiving first-line ICI monotherapy.
- Comparison of PFS and OS between patients with different metastatic sites (liver, bone, brain, adrenal gland, pleura, contralateral lung) and metastatic burden using Kaplan-Meier method.
- Evaluation of organ-specific disease control rate (OSDCR) for individual metastatic sites.
Main Results:
- Liver metastasis was significantly associated with shorter PFS and OS (P < 0.005).
- Bone metastasis showed a trend towards shorter PFS (P = 0.0532).
- Increased number of metastatic organs correlated with inferior PFS (P = 0.0052), and liver/bone metastasis indicated higher metastatic burden (P = 0.001). OSDCR was highest in lung and lowest in liver.
Conclusions:
- Metastatic site significantly influences clinical outcomes and local response to ICIs in NSCLC.
- ICI monotherapy demonstrates limited efficacy in patients with liver and bone metastases.
- Patients with liver or bone metastases may benefit from more aggressive combination treatment strategies.
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