■基于程序性细胞死亡蛋白-1(PD-1)抑制剂的治疗在转移性胃癌(MGC)中已证明有希望的结果。然而,以前的研究大多是临床试验,并得出了各种结论。我们的目标是研究以PD-1抑制剂为基础的治疗作为MGC的一线治疗的疗效。利用来自中国的真实世界数据,并进一步分析预测生物标志物的疗效。
这项回顾性研究包括2018年1月至2022年12月在四川大学华西医院接受多种基于PD-1抑制剂的一线治疗的105例诊断为MGC的患者。患者特征,治疗方案,并提取肿瘤反应。我们还进行了单变量和多变量分析,以评估临床特征和治疗结果之间的关系。此外,我们评估了几种常用的生物标志物对PD-1抑制剂治疗的预测疗效.
■总的来说,在我们研究的105名患者中进行了28.0个月的随访,客观反应率(ORR)为30.5%,治疗后疾病控制率(DCR)为89.5%,2名患者(1.9%)达到完全缓解(CR)。中位无进展生存期(mPFS)为9.0个月,中位总生存期(mOS)为22.0个月.根据单变量和多变量分析,有利的OS与东部肿瘤协作组表现状态(ECOGPS)为0-1的患者相关.此外,癌胚抗原(CEA)的正常基线水平,以及PD-1抑制剂联合化疗和曲妥珠单抗治疗人表皮生长因子受体2(HER2)阳性MGC患者,独立预测较长的PFS和OS。然而,微卫星不稳定/错配修复(MSI/MMR)状态和EB病毒(EBV)感染状态与PFS或OS延长没有显着相关。
■作为一线治疗,PD-1抑制剂,作为单一疗法或联合疗法,有望延长转移性胃癌患者的生存期。此外,CEA的基线水平是一种潜在的预测生物标志物,可用于识别对PD-1抑制剂有主要反应的患者.
UNASSIGNED: Programmed cell death protein-1 (PD-1) inhibitor-based therapy has demonstrated promising results in metastatic gastric cancer (MGC). However, the previous researches are mostly clinical trials and have reached various conclusions. Our objective is to investigate the efficacy of PD-1 inhibitor-based treatment as first-line therapy for MGC, utilizing real-world data from China, and further analyze predictive biomarkers for efficacy.
UNASSIGNED: This retrospective study comprised 105 patients diagnosed with MGC who underwent various PD-1 inhibitor-based treatments as first-line therapy at West China Hospital of Sichuan University from January 2018 to December 2022. Patient characteristics, treatment regimens, and tumor responses were extracted. We also conducted univariate and multivariate analyses to assess the relationship between clinical features and treatment outcomes. Additionally, we evaluated the predictive efficacy of several commonly used biomarkers for PD-1 inhibitor treatments.
UNASSIGNED: Overall, after 28.0 months of follow-up among the 105 patients included in our study, the objective response rate (ORR) was 30.5%, and the disease control rate (DCR) was 89.5% post-treatment, with two individuals (1.9%) achieving complete response (CR). The median progression-free survival (mPFS) was 9.0 months, and the median overall survival (mOS) was 22.0 months. According to both univariate and multivariate analyses, favorable OS was associated with patients having Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-1. Additionally, normal baseline levels of carcinoembryonic antigen (CEA), as well as the combination of PD-1 inhibitors with chemotherapy and trastuzumab in patients with human epidermal growth factor receptor 2 (HER2)-positive MGC, independently predicted longer PFS and OS. However, microsatellite instability/mismatch repair (MSI/MMR) status and Epstein-Barr virus (EBV) infection status were not significantly correlated with PFS or OS extension.
UNASSIGNED: As the first-line treatment, PD-1 inhibitors, either as monotherapy or in combination therapy, are promising to prolong survival for patients with metastatic gastric cancer. Additionally, baseline level of CEA is a potential predictive biomarker for identifying patients mostly responsive to PD-1 inhibitors.