化疗加免疫疗法作为第一线组合在老年患者的广泛阶段小细胞肺癌:一个系统的审查和元分析
Valentina Bertaglia1, Fausto Petrelli2, Lorenzo Dottorini2
1Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
Seminars in oncology
|January 1, 2025
概括
将免疫检查点抑制剂 (ICI) 添加到化疗中,可以显著改善患有扩散阶段小细胞肺癌 (ES-SCLC) 的老年患者的整体存活率. 需要进一步的研究来确定最佳的患者选择策略.
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:
- 小细胞肺癌 (SCLC) 具有侵略性,大多数患者在广泛阶段 (ES) 才被诊断出来.
- 老年人 (≥70岁) 占SCLC诊断的很大一部分,但在临床试验中代表性不足.
- 免疫检查点抑制剂 (ICI) 与化疗相结合已成为ES-SCLC的标准一线治疗方法.
研究的目的:
- 系统地审查与PD-1/PD-L1免疫检查点抑制剂 (ICI) 结合化疗在以前未经治疗的大型小细胞肺癌 (ES-SCLC) 的老年患者的疗效.
- 解决老年人在ES-SCLC临床试验中的代表性不足问题.
主要方法:
- 随机临床试验的系统审查和元分析是按照PRISMA指南进行的.
- 搜索包括试验评估化疗与或没有PD-1/PD-L1ICI,优先研究更长的随访和更大的患者队列.
- 主要终点是总生存率 (OS),无进展生存率 (PFS) 和疾病控制率 (DCR).
主要成果:
- 包括6项随机试验,包括3396名患者. 在65岁及以上的小组患者中,添加ICI与化疗显示出整体存活率的显著改善 (HR 0.80;95%CI 0.72-0.90).
- 在试验中观察到适度的异质性 (I2 = 47%,P = 0.07),表明总体上一致的结果.
结论:
- 化疗和ICI的结合显著改善了ES-SCLC老年患者的整体存活率.
- 生物标志物分析和综合老年评估对于更好地识别和选择将从这种治疗方法中获益最多的老年患者至关重要.
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