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ZHANG Xianwen, SUN Qian, CAI Feng, ZHAO Mengdie, SONG Shilong, CHEN Rujun, JIANG Hao. Prognostic analysis of radiotherapy combined with PD-1 inhibitors in patients with driver-gene negative non-small cell lung cancer and brain metastases[J]. Chinese Journal of General Practice, 2024, 22(12): 2016-2019. doi: 10.16766/j.cnki.issn.1674-4152.003787
Citation: ZHANG Xianwen, SUN Qian, CAI Feng, ZHAO Mengdie, SONG Shilong, CHEN Rujun, JIANG Hao. Prognostic analysis of radiotherapy combined with PD-1 inhibitors in patients with driver-gene negative non-small cell lung cancer and brain metastases[J]. Chinese Journal of General Practice, 2024, 22(12): 2016-2019. doi: 10.16766/j.cnki.issn.1674-4152.003787
shu

Prognostic analysis of radiotherapy combined with PD-1 inhibitors in patients with driver-gene negative non-small cell lung cancer and brain metastases

doi: 10.16766/j.cnki.issn.1674-4152.003787

  • Department of Radiotherapy, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

Funds:

 82403993

 2021byzd159

 202304295107020078

  • Received Date: 2024-10-08
    Abstract
  •   Objective  Observation of the efficacy and adverse reactions of combined treatment of cranial radiation therapy (RT) and programmed death-1 (PD-1) inhibitors in patients with driver gene negative non-small cell lung cancer (NSCLC) with brain metastases (BMs), and exploration of its clinical application value.  Methods  A total of 90 NSCLC BM patients who received RT at the First Affiliated Hospital of Bengbu Medical University from January 2021 to July 2023 were included. They were divided into the radiotherapy group (40 cases) and the combination group (50 cases), based on whether they were treated with PD-1 inhibitors. Kaplan-Meier method and Cox regression model were used to evaluate intracranial short-term efficacy, intracranial local progression free survival (iLPFS), intracranial distant progression free survival (iDPFS), and overall survival (OS).  Results  By July 2024, the intracranial objective response rate (iORR) was 45.0% and 72.0% in the radiotherapy group and the combination group, respectively (P=0.009). The median iLPFS, iDPFS, and OS for the radiotherapy group were 11 months (95% CI: 8.77-13.23), 14 months (95% CI: 7.69-20.31), and 14 months (95% CI: 11.98-16.02), respectively. In the combination group, the corresponding medians were 22 months (95% CI: 18.23-25.77), 21 months (95% CI: 13.24-28.76), and 21 months (95% CI: 17.63-24.37), respectively, with statistically significant differences (P < 0.05). Univariate and multivariate analysis showed that combined PD-1 inhibitor therapy is an independent prognostic factor for iLPFS and iDPFS. Stratified analysis showed that early intervention of RT, especially when synchronized with PD-1 inhibitors (≤ 2 weeks), resulted in significantly improved iLPFS (P=0.007) and iDPFS (P=0.027), though no statistically significant difference was observed in OS (P=0.385). Both groups of patients tolerated adverse reactions.  Conclusion  The combination therapy of RT and PD-1 inhibitors, especially when administered simultaneously (≤ 2 weeks), improves iLPFS and iDPFS in patients with driver gene-negative NSCLC BMs, contributing to improved OS.

     

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