Br J Cancer:免疫检查点抑制剂ICI预治疗提高达卡巴嗪治疗转移性黑色素瘤的疗效

2021-07-18 xiaozeng MedSci原创

既往研究显示,免疫检查点抑制剂(ICI)以及靶向治疗等新型疗法能够极大提高晚期黑色素瘤患者的生存率。

既往研究显示,免疫检查点抑制剂(ICI)以及靶向治疗等新型疗法能够极大提高晚期黑色素瘤患者的生存率。采用BRAF和MEK抑制剂的靶向治疗策略具有诱导快速反应的优势,而使用抗CTLA-4(细胞毒性T淋巴细胞抗原4,ipilimumab)和抗PD-1(程序性细胞死亡蛋白1,nivolumab、pembrolizumab)ICI的单克隆抗体(mAb)可诱导持久治疗反应。

由于BRAF+MEK抑制剂在一线和二线治疗中显示出相似的疗效,而抗PD-1 mAb在二线中的疗效较低,因此目前推荐ICI作为所有BRAF野生型和大多数BRAF V600突变的黑色素瘤患者的一线治疗药物。

然而,有很大一部分患者在治疗后会出现疾病的进展:靶向治疗、派姆单抗(pembrolizumab)单药治疗和纳武单抗(nivolumab)联合伊匹单抗(ipilimumab)治疗的5年总生存率(OS)分别为34%、39%和52% 。


尽管疗效较低,但在ICI±靶向治疗失败后,达卡巴嗪(dacarbazine)化疗仍是转移性黑色素瘤患者的一种选择。既往的一些观察性研究显示,化疗对先前接受过ICI治疗的黑色素瘤或肺癌患者的疗效有所提高。因此,该研究旨在评估达卡巴嗪在ICI预治疗或未治疗患者中的疗效。

研究流程图

该回顾性研究共收集了2006年6月至2019年9月在皮肤癌中心接受达卡巴嗪治疗的无脑转移的晚期黑色素瘤患者的数据。研究的主要终点为无进展生存期(PFS),次要终点为达卡巴嗪的总缓解率(ORR)、患者的总生存期(OS)以及药物的安全性。


结果显示,共收集了72名患者的数据,其中17名(23.6%)在ICI治疗后接受达卡巴嗪治疗,55名(76.3%)未接受过ICI治疗。尽管ICI预治疗患者的预后因素较差,但该组的中位PFS为4.27个月(范围0.89-43.69个月),而未接受ICI治疗的患者的中位PFS为2.04个月(范围1.25-39.25个月)。两组ORR分别为35.3%和12.7%。两组的中位OS和不良事件的发生率相似。

患者达卡巴嗪治疗的无进展生存期

总而言之,该研究结果发现,在ICI预治疗的患者中,达卡巴嗪对进展性晚期疾病患者提供了短暂的益处,且在考虑最佳支持治疗之前其可以作为替代方案。


原始出处:

Bouchereau, S., Chaplain, L., Fort, M. et al. Impact of prior treatment with immune checkpoint inhibitors on dacarbazine efficacy in metastatic melanoma. Br J Cancer (14 July 2021).

 

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    2021-12-29 jklm09
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    2022-02-13 sunylz
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  5. 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  6. 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  7. 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  8. 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    2021-07-19 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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