PDF(Pubmed)
Abstract：
OBJECTIVE: To evaluate the feasibility and outcomes of performing procedural interventions, defined as surgical resection, tumor ablation, or targeted radiation therapy, for oligoprogressive disease among patients with gynecologic malignancies who are treated with immune checkpoint blockade.
METHODS: Patients with gynecologic cancers treated with immune checkpoint blockade between January 2013 and October 2021 who underwent procedural interventions including surgical resection, interventional radiology ablation, or radiation therapy for oligoprogressive disease were identified. Procedures performed before immune checkpoint therapy initiation or ≥6 months after therapy completion were excluded. Long immunotherapy duration prior to intervention was defined as ≥6 months. Progression-free survival and overall survival were calculated from procedure date until disease progression or death, respectively.
RESULTS: During the study period, 886 patients met inclusion criteria and received immune checkpoint blockade therapy. Of these, 34 patients underwent procedural interventions for oligoprogressive disease; 7 underwent surgical resection, 3 underwent interventional radiology ablation, and 24 underwent radiation therapy interventions. Primary disease sites included uterus (71%), ovary (24%), and cervix (6%). Sites of oligoprogression included abdomen/pelvis (26%), bone (21%), lung (18%), distant lymph node (18%), brain (9%), liver (6%), and vagina (3%). Most tumors (76%) did not exhibit microsatellite instability or mismatch repair deficiency. Approximately half (53%) of the patients had long immune checkpoint therapy duration prior to intervention. Median progression-free survival following the procedure was 5.3 months (95% CI, 3.1-9.9), and median overall survival was 21.7 months (95% CI, 14.9-not estimable). Long versus short immune checkpoint therapy duration prior to procedure and length of immune checkpoint therapy had no effect on progression-free or overall survival.
CONCLUSIONS: Procedural interventions for patients with oligoprogression on immune checkpoint blockade therapy are feasible and demonstrate favorable outcomes. With expanding use of immune checkpoint therapy, it is important to investigate combined modalities to maximize therapeutic benefit for patients with gynecologic cancers.
METHODS: Patients with gynecologic cancers treated with immune checkpoint blockade between January 2013 and October 2021 who underwent procedural interventions including surgical resection, interventional radiology ablation, or radiation therapy for oligoprogressive disease were identified. Procedures performed before immune checkpoint therapy initiation or ≥6 months after therapy completion were excluded. Long immunotherapy duration prior to intervention was defined as ≥6 months. Progression-free survival and overall survival were calculated from procedure date until disease progression or death, respectively.
RESULTS: During the study period, 886 patients met inclusion criteria and received immune checkpoint blockade therapy. Of these, 34 patients underwent procedural interventions for oligoprogressive disease; 7 underwent surgical resection, 3 underwent interventional radiology ablation, and 24 underwent radiation therapy interventions. Primary disease sites included uterus (71%), ovary (24%), and cervix (6%). Sites of oligoprogression included abdomen/pelvis (26%), bone (21%), lung (18%), distant lymph node (18%), brain (9%), liver (6%), and vagina (3%). Most tumors (76%) did not exhibit microsatellite instability or mismatch repair deficiency. Approximately half (53%) of the patients had long immune checkpoint therapy duration prior to intervention. Median progression-free survival following the procedure was 5.3 months (95% CI, 3.1-9.9), and median overall survival was 21.7 months (95% CI, 14.9-not estimable). Long versus short immune checkpoint therapy duration prior to procedure and length of immune checkpoint therapy had no effect on progression-free or overall survival.
CONCLUSIONS: Procedural interventions for patients with oligoprogression on immune checkpoint blockade therapy are feasible and demonstrate favorable outcomes. With expanding use of immune checkpoint therapy, it is important to investigate combined modalities to maximize therapeutic benefit for patients with gynecologic cancers.
摘要：
目的：评估进行程序性干预的可行性和结果，定义为手术切除，肿瘤消融,或者靶向放射治疗,对于接受免疫检查点阻断治疗的妇科恶性肿瘤患者中的少进展性疾病。
方法：2013年1月至2021年10月期间接受免疫检查点阻断治疗的妇科癌症患者，接受了包括手术切除在内的手术干预，介入放射学消融，或少进展性疾病的放射治疗被确定。免疫检查点治疗开始前或治疗完成后≥6个月进行的程序被排除。干预前的长免疫治疗持续时间定义为≥6个月。从手术日期到疾病进展或死亡，计算无进展生存期和总生存期。分别。
结果：在研究期间，886例患者符合纳入标准并接受免疫检查点阻断治疗。其中,34例患者接受了少进展性疾病的手术干预；7例接受了手术切除，3人接受了介入放射学消融，24人接受了放射治疗干预。原发疾病部位包括子宫（71%），卵巢（24%），子宫颈（6%）。少进展部位包括腹部/骨盆（26%），骨（21%），肺（18％），远处淋巴结（18％），大脑（9%），肝脏（6%），阴道（3%）。大多数肿瘤（76％）没有表现出微卫星不稳定性或错配修复缺陷。大约一半（53％）的患者在干预前具有较长的免疫检查点治疗持续时间。术后中位无进展生存期为5.3个月（95%CI，3.1-9.9），中位总生存期为21.7个月(95%CI,14.9-不可估计).手术前的长免疫检查点治疗持续时间和免疫检查点治疗的长度对无进展或总生存期没有影响。
结论：对免疫检查点阻断治疗的少进展患者进行程序性干预是可行的，并显示出良好的结局。随着免疫检查点疗法使用的扩大，研究联合治疗模式以最大限度地提高妇科癌症患者的治疗效益非常重要.
方法：2013年1月至2021年10月期间接受免疫检查点阻断治疗的妇科癌症患者，接受了包括手术切除在内的手术干预，介入放射学消融，或少进展性疾病的放射治疗被确定。免疫检查点治疗开始前或治疗完成后≥6个月进行的程序被排除。干预前的长免疫治疗持续时间定义为≥6个月。从手术日期到疾病进展或死亡，计算无进展生存期和总生存期。分别。
结果：在研究期间，886例患者符合纳入标准并接受免疫检查点阻断治疗。其中,34例患者接受了少进展性疾病的手术干预；7例接受了手术切除，3人接受了介入放射学消融，24人接受了放射治疗干预。原发疾病部位包括子宫（71%），卵巢（24%），子宫颈（6%）。少进展部位包括腹部/骨盆（26%），骨（21%），肺（18％），远处淋巴结（18％），大脑（9%），肝脏（6%），阴道（3%）。大多数肿瘤（76％）没有表现出微卫星不稳定性或错配修复缺陷。大约一半（53％）的患者在干预前具有较长的免疫检查点治疗持续时间。术后中位无进展生存期为5.3个月（95%CI，3.1-9.9），中位总生存期为21.7个月(95%CI,14.9-不可估计).手术前的长免疫检查点治疗持续时间和免疫检查点治疗的长度对无进展或总生存期没有影响。
结论：对免疫检查点阻断治疗的少进展患者进行程序性干预是可行的，并显示出良好的结局。随着免疫检查点疗法使用的扩大，研究联合治疗模式以最大限度地提高妇科癌症患者的治疗效益非常重要.
