■骨转移(BoMs)在转移性非小细胞肺癌(NSCLC)患者中普遍存在,关于BoM对免疫检查点抑制剂(ICIs)的反应的数据有限.这项研究的目的是比较BoMs对ICIs的成像反应与内脏转移的反应,并评估BoMs对生存的影响。
■回顾,多中心队列研究是在阿尔伯塔省接受纳武单抗或派博利珠单抗治疗的NSCLC患者中进行的,加拿大从2015年到2020年。主要终点是骨与内脏转移的真实世界器官特异性无进展生存期(osPFS)。内脏转移被归类为肾上腺,大脑,肝脏,肺,淋巴结,或其他腹内病变。次要结果是有和没有BoM的患者的总生存期(OS)。
■总共包括573例患者,其中所有患者均有内脏转移,243例患者(42.4%)有BoM。268例患者(46.8%)中发现PD-L1高表达。骨之间的osPFS没有显着差异,肝脏,和腹腔内转移(分别为p=0.20和p=0.76),与所有显示比其他疾病部位更短的osPFS。PD-L1高表达患者胸外部位的osPFS无差异。内脏疾病反应和骨病对ICI的反应之间存在显著的不一致(p=0.047)。BoM的存在是OS的独立不良预后因素(HR1.26,95CI:1.05-1.53,p=0.01)。
■转移骨,肝脏,与其他疾病部位相比,腹腔内病变对ICI的临床反应较差。此外,骨转移和肝转移是影响总生存期的独立不良预后因素.这些现实世界的数据表明,BoM对ICI的反应较差,可能需要治疗辅助手段来控制疾病。
UNASSIGNED: Bone metastases (BoMs) are prevalent in patients with metastatic non-small-cell lung cancer (NSCLC) however, there are limited data detailing how BoMs respond to immune checkpoint inhibitors (ICIs). The purpose of this study was to compare the imaging response to ICIs of BoMs against visceral metastases and to evaluate the effect of BoMs on survival.
UNASSIGNED: A retrospective, multicentre cohort study was conducted in patients with NSCLC treated with nivolumab or pembrolizumab in Alberta, Canada from 2015 to 2020. The primary endpoint was the real-world organ specific progression free survival (osPFS) of bone versus visceral metastases. Visceral metastases were categorized as adrenal, brain, liver, lung, lymph node, or other intra-abdominal lesions. The secondary outcome was overall survival (OS) amongst patients with and without BoMs.
UNASSIGNED: A total of 573 patients were included of which all patients had visceral metastases and 243 patients (42.4%) had BoMs. High PD-L1 expression was identified in 268 patients (46.8%). No significant difference in osPFS was observed between bone, liver, and intra-abdominal metastases (p=0.20 and p=0.76, respectively), with all showing shorter osPFS than other disease sites. There was no difference in the osPFS of extra-thoracic sites of disease in patients with high PD-L1 expression. There was significant discordance between visceral disease response and bone disease response to ICI (p=0.047). The presence of BoMs was an independent poor prognostic factor for OS (HR 1.26, 95%CI: 1.05-1.53, p=0.01).
UNASSIGNED: Metastatic bone, liver, and intra-abdominal lesions demonstrated inferior clinical responses to ICI relative to other sites of disease. Additionally, the presence of bone and liver metastases were independent poor prognostic factors for overall survival. This real-world data suggests that BoMs respond poorly to ICI and may require treatment adjuncts for disease control.