在肺癌新辅助疗法后,病理反应和存活率之间的关联
Julie Stein Deutsch1, Ashley Cimino-Mathews1, Elizabeth Thompson1
1Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nature medicine
|October 30, 2023
概括
新辅助剂尼沃卢马布加化疗改善了可切除肺癌无事件生存率. 通过剩余可行的瘤百分比来衡量病理反应,是生存结果的强有力的预测指标.
科学领域:
- 在瘤学瘤学.
- 翻译研究是翻译研究.
- 临床试验 临床试验
背景情况:
- 新辅助免疫疗法加化疗已被批准用于切除的肺癌,改善无事件生存率 (EFS) 和病理完整反应.
- 病理反应评估对于评估新辅助疗法疗效至关重要,类似于晚期疾病的放射性反应.
- 需要对超出当前基准值的剩余可活性瘤 (%RVT) 值进行探索.
研究的目的:
- 在CheckMate 816试验中使用%RVT前性评估病理反应.
- 在接受新辅助药尼沃卢马布加化疗的患者中研究%RVT和EFS之间的关联.
- 为了将%RVT与其他响应指标比较,例如放射性响应和循环瘤DNA清除.
主要方法:
- 病理反应的前性评估,包括%RVT,回归和初级瘤和淋巴结的缩 (0-100%).
- 使用泛瘤评分系统进行RVT量化.
- 在3期随机试验 (CheckMate 816) 中,对RVT与EFS的%关联进行探索性分析.
主要成果:
- 在初级瘤中,0%的RVT显著改善了EFS,而初级瘤的RVT>0% (危险比率=0.18).
- 主要瘤中的%RVT预测了EFS,两年EFS的发病率从90% (0-5%RVT) 到39% (>80%RVT) 不等.
- %RVT与EFS的关联比放射性反应或循环瘤DNA清除更强.
结论:
- 病理反应,特别是%RVT,是用新辅助药尼沃卢马布加化疗治疗可切除肺癌中EFS的强有力的预测指标.
- %RVT的全谱是生存的宝贵替代品,并保证在肺癌和其他恶性瘤中进行进一步的研究.
- 病理反应评估为评估新辅助治疗疗效提供了一个有希望的途径.
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