Real-world data! PD1 drug resistance continues to benefit!

introduction sits
authorsQiu Lixin works in oncology medicine at Fudan University's Affiliated Oncology HospitalMainly engaged in gastric cancer, bowel cancer and other malignant tumors of chemotherapy, targeted treatment, immunotherapy and researchHe founded the public number "Qiulixinyison", a public name for cancer sciencepublished 65 SCI papers in International Journal of Cancer, European Journal of Cancer, etc., with a cumulative impact factor of about 300 points, of which the first or parallel first author SCI paper 40, the cumulative impact factor of about 180 pointsDeputy Editor-in-Chief of "Winning in Papers" and "Practical Evidence-Based Medical Methodology" is a compilationResponsible for the National Natural Science Foundation of China, China Clinical Oncology Science Foundation, etcWon the second prize of scientific and technological progress of the Ministry of Education, the third prize of Shanghai Medical Science and Technology Progress Award, the second prize of the first Youth Scholars Forum of Shanghai Medical College, etcimmunotherapy is currently in addition to manufacturers, media publicity, the word of mouth between cancer patients, the "immunotherapy PD-1/PD-L1" to the altarWhether it is after surgery patients hope to prevent recurrence through immunotherapy, or some newly examined tumor patients hope to achieve a cure through immunotherapy, more late-term end-of-life (only bed, can not eat, etc.) patients want to seize the life-saving straw of immunotherapyThe current immunotherapy PD-1/PD-L1 is effective, but even after PD-1/PD-L1 works, 15%-35% of patients develop resistanceHow to treat after drug resistance? Recently, Clinical Lung Cancer published more than 4,000 large sample studies of TBP in the real world (continued use after progress in immunotherapy), providing immuno-resistant treatment ideas for "don't change drugs in a hurry."research designthis retrospective, observational, multicenter analysis assessed uncertain electronic health records data from community clinics in the United States Patients have been identified as non-small cell lung cancer (NSCLC), began using anti-PD-(L)1 inhibitors (nivolumab, pembrolizumab or atezolizumab) by 1 October 2018, and have experienced disease progression (rwP) events The study period ends on March 31, 2019 The main goal is to compare the total lifetime (OS) of patients who terminate immunotherapy with the total lifetime (non-TBP) and the total survival of the patients who have terminated immunotherapy by 30 days (non-TBP) and the total survival period greater than 30 days (TBP) after discontinuation also compared OS sensitivity analysis to patients who were still undergoing immunotherapy for more than 60 days after the first rwP event and those who stopped treatment before that point the results of the study
analyzed a total of 4,223 patients Non-TBP and TBP queues were 2,555 (60.5%) and 1,668 (39.5%) respectively The median treatment time was 2.8 months for non-TBP and TBP patients, and the was 9.1 months (log-rank 0.001) Compared to non-TBP, TBP patients had longer unadjusted OS (11.5 vs 5.1 months, nob order 0.001) The benefits of TBP OS persisted (aHR: 0.69, p 0.001) after the clinically relevant patient characteristics were adjusted mean that, compared to patients who stopped taking the drug immediately, the continued use of the drug after a period of time can also bring survival benefits, reducing the risk of death by 31% extendthed the threshold for continued immunity with TBP group to 60 days (TBP continues to use PD for 60 days after patient progression, non-TBP is discontinued for 60 days), and the median OS in TBP patients is longer (11.5 months (95% CI: 10.5, 12.4) and 7.5 months ( 95% CI: 7.1, 7.9) ;p the conclusion sat the study
contemporary large-scale reality data sets with a selection of rwP data can provide important and clinically relevant insights In past progress, it may be effective to continue to treat real-world NSCLC patients with immunotherapy Further research is needed to deepen our understanding of clinicians' decisions to continue treatment and whether clinical factors not included in the analysis, such as deep initial reactions or tumor burdens in progress, play a role Other studies can also assess whether the survival benefits observed in this study are appropriate for other cancers and environments using immunotherapy Whether past advances in immunotherapy will change the prognosis of follow-up treatment in patients remains to be seen As the complexity and pace of cancer treatment discovery accelerates, it is critical to assess the effectiveness of emerging real-world treatments in a timely manner PD1 plus population characteristics: receiving K medicine, O drug NSCLC patients, mostly for the latter treatment we identified 207 patients with advanced NSCLC who were continuously treated with nivolumab or pembrolizumab between February 2015 and June 2017 at the Davidoff Cancer Center Exclude patients who received a combination of chemotherapy plus ICI or CTLA4-PD1 inhibition 151 patients received nivolumab and 56 patients received pembrolizumab A total of 31 patients received first-line treatment of ICI, of which 121 were second-line treatment and 49 were third- or fourth-line treatment patients were divided into two groups: patients received "classic" TBP and continued to use monodotherapy against PD1 in progress without additional treatment, and patients who continued to treat anti-PD1 during progress, while radiation or surgery were performed at the active site All patients were assessed for baseline imaging at least one month prior to the start of treatment Patients in the TBP group were evaluated for radiology 8-12 weeks after the first progression Six patients were evaluated for radiology after four weeks due to rapid clinical progress The results showed that the median PFS in the entire patient queue treated with ICI was 4.5 months the median PFS of the entire patient queue treated with ICI was 4.5 months the median PFS in the entire patient queue treated with ICI was
4.5 months after PD1 resistance The median OS is 22.6 months The mitigation rate was 26% and the median DOR was 22 months Patients receiving "classic" TBP were less likely to have the best control response (31%) than the entire queue (58 percent ;p 0.008) Patients who received local treatment for the less protrusion site were more likely to have the best clinical benefit (92%; not significant; p 0.17) continue to use after the progress of immunization, without combining other treatment options, the clinical benefit rate can also have 35%! a total of 35 patients (17%) received TBP while using the same treatment regimen, and there was no other treatment during the progression However, 28 of these patients received nivolumab and 7 patients received pembrolizumab A total of 34% (12/35) received clinical benefits (6 stable SDs, 6 remission Prs) The median no progression interval from the first to the second in the subgroup was 2.7 months, with 23% (8/35) of patients progressing no more than 6 months after TBP PD1 progress, first with local treatment (such as radiotherapy), and then continue to use immunity, the effect is good! 9 patients received radiotherapy on residual active sites or individual/less progressive sites at the initial progression and continued to receive ICI after these treatments The time for radiotherapy is 1 to 2 months after progression Four of these patients developed a sustained reaction after radiotherapy and ONgoing ICI treatment (no progress, according to the last follow-up), followed by PD1 monoantigens Source: Dr Qiu Lixin