免疫疗法或化疗免疫疗法在老年人与高级非小细胞肺癌的老年人
Yoko Tsukita1, Takehiro Tozuka2, Kohei Kushiro3
1Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
JAMA oncology
|March 7, 2024
概括
免疫检查点抑制剂 (ICI) 加上化疗并没有改善患有非小细胞肺癌 (NSCLC) 的老年人生存率. 与单独ICI相比,这种组合也增加了严重的副作用,这表明ICI单疗可能更适合老年NSCLC患者.
科学领域:
- 在瘤学瘤学.
- 免疫治疗是一种免疫疗法.
- 老年医学 老年医学
背景情况:
- 免疫检查点抑制剂 (ICI) 加上化疗是缺乏可向的瘤基因改变的非小细胞肺癌 (NSCLC) 的标准治疗方法.
- 在75岁及以上的患者中,ICI化疗的疗效和安全性数据有限.
研究的目的:
- 评估一线ICI化疗对75岁及以上的晚期NSCLC患者的安全性和疗效.
- 为临床实践提供有关该人口群体治疗选择的信息.
主要方法:
- 在日本的58个中心对1245名晚期NSCLC患者 (≥75岁) 进行了回顾性队列研究.
- 患者在2018年12月至2021年3月期间接受了第一线全身治疗 (ICI化疗,单独ICI,双重化疗或单剂化疗).
- 结果包括整体生存 (OS),无进展生存 (PFS) 和安全,分析时间为2022年2月至2022年10月.
主要成果:
- 在倾向性得分匹配后,ICI-化疗 (n=354) 显示了与单独ICI (n=425; 19.8个月) 相似的中位数OS (20.0个月) 和PFS.
- 在ICI化疗和ICI单独之间,无论PD-L1表达水平如何,都没有观察到OS或PFS的显著差异.
- 与ICI化学疗法 (24.3%) 相比,与ICI单独 (17.9%) 相比,III级或更高的免疫相关不良事件更频繁.
结论:
- 与单独使用ICI相比,一线ICI化疗并没有改善75岁及以上晚期NSCLC患者的生存结果.
- 组合治疗与严重的免疫相关不良事件的发病率更高有关.
- 对于PD-L1-阳性NSCLC的老年成人患者来说,ICI单疗可能是首选的选择.
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