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Author: haixin This article is published by Yimaitong authorized by the author, please do not reprint without authorization
.
When it comes to immunotherapy, it is often heard that a major feature of immunotherapy is that it has a long-lasting effect (tailing effect).
Once it works, it can be maintained for a long time
.
So can patients who are effective on PD-1 inhibitors continue to use it after 1 year? Case introduction 1.
Basic information of the patient Li xx, male, 67 years old
.
2018-10-26 due to "chest pain with chest tightness and shortness of breath for 1 week after activity"
.
He has a history of COPD and no history of tuberculosis
.
Long-term smoking history for 30 years, with an average of 40 cigarettes per day
.
No family history of tumor
.
2.
Imaging chest CT before treatment: space-occupying lesions of the right upper lobe with necrosis (5.
1×5.
9×6cm), partial atelectasis changes, encapsulated pleural effusion on the right side, and local pleural invasion cannot be excluded
.
Swollen lymph nodes in the mediastinum
.
Head CT showed multiple brain metastases, accompanied by peripheral edema
.
3.
Pathological results: Lung penetration pathology: (upper right lung) poorly differentiated carcinoma, combined with immunohistochemistry, conforms to poorly differentiated adenocarcinoma
.
Immunohistochemistry: CgA(-), P63(-), Syn(-), TTF(+), CK5/6(-), Ki67(50%+), CK7(+), Napsina(-)
.
Genetic examination showed that there were no mutations in the detected sites of EGFR, ALK, ROS1, BRAF and KRAS
.
4.
Clinical diagnosis of left lung adenocarcinoma, multiple brain metastases
.
Stage: cT4N2M1 IV stage, negative driver gene
.
5.
Diagnosis and treatment After diagnosis and treatment: From December 6, 2018 to April 13, 2019, 6 cycles of pemetrexed 800mg d1 + cisplatin 40mg d1 q3w were given (the last 4 cycles were combined with bevacizumab 400mg)
.
From 2019-6-10 to 2019-8-13, pemetrexed 800mg monotherapy was maintained for 3 times
.
During chemotherapy, he received whole brain radiotherapy (PTV 3000cGy/10 times) due to multiple brain metastases on November 20, 2018
.
Tumor progression image 2019-12-25 Chest CT: The mass of the upper lobe of the right lung is strongly enlarged (33x87mm), adjacent to the pleura and ribs
.
2019-12-29 MR head enhancement: consideration of new metastases in the cerebellar hemispheres on both sides
.
The efficacy evaluation in December 2019 was tumor progression
.
Diagnosis and treatment process 2: The patient was undergoing single-drug carrelizumab 200mg q3w immune maintenance therapy 23 times (about 1.
5 years) from 2020-02-01 to 2021-07-04
.
Efficacy evaluation: no new distant lesions, stable disease (SD), and PS score 1 point
.
Adverse reactions: Grade I skin capillary hyperplasia (RCCEP)
.
Images during 1 year of PD-1 inhibitor treatment.
Chest CT and head MRI of patients every 3-6 months.
During 1 year of PD-1 inhibitor treatment, regular chest CT and head MRI suggest SD
.
CheckMate153 study Continuous Versus 1-Year Fixed-Duration Nivolumab in Previously Treated Advanced Non-Small-Cell Lung Cancer: CheckMate 153 The CheckMate153 study is the first randomized clinical study to evaluate the duration of PD-1 inhibitor treatment
.
The study included a total of 1,428 patients with advanced non-small cell lung cancer.
After 1 year of treatment with nivolumab, 252 effective patients continued to be divided into two groups: group A was continuous medication group (n=127) and group B was drug discontinuation Group (n=125) study results 1.
For patients with complete remission/partial remission (CR/PR), it is strongly recommended to extend the treatment time of PD-1 monoclonal antibody; 2.
For those with SD effect, prolong the survival of PD-1 monoclonal antibody treatment The benefits are limited
.
Summarizing the recommendations of relevant domestic and foreign guidelines, for patients with PD-1 inhibitors (CR/PR), it is not recommended to stop the drug at will, and the recommended use time is 2 years; for SD patients, use it for 1 year, and then extend it Time does not bring survival benefits
.
References: 1.
Waterhouse DM, Garon EB, Chandler J, et al.
Continuous Versus 1-Year Fixed-Duration Nivolumab in Previously Treated Advanced Non-Small-Cell Lung Cancer: CheckMate 153.
J Clin Oncol.
2020;38(33 ):3863-3873.
2.
Borghaei H, Paz-Ares L, Horn L, et al.
Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer.
N Engl J Med.
2015;373(17):1627- 1639.
3.
2021 version of "NCCN non-small cell lung cancer clinical diagnosis and treatment guidelines".
4.
Wu Liusheng, Liu Jixian, Wu Da, Luan Xinyu, Luo Ruixing, Hou Qinghua, Liu Linzhuang, Wu Dingwang, Xu Pengcheng, Li Xiaoqiang.
PD-1/PD- Research progress of L1 immunosuppressant in immunotherapy of non-small cell lung cancer[J].
Journal of Oncology,2021,27(09):710-715.
.
When it comes to immunotherapy, it is often heard that a major feature of immunotherapy is that it has a long-lasting effect (tailing effect).
Once it works, it can be maintained for a long time
.
So can patients who are effective on PD-1 inhibitors continue to use it after 1 year? Case introduction 1.
Basic information of the patient Li xx, male, 67 years old
.
2018-10-26 due to "chest pain with chest tightness and shortness of breath for 1 week after activity"
.
He has a history of COPD and no history of tuberculosis
.
Long-term smoking history for 30 years, with an average of 40 cigarettes per day
.
No family history of tumor
.
2.
Imaging chest CT before treatment: space-occupying lesions of the right upper lobe with necrosis (5.
1×5.
9×6cm), partial atelectasis changes, encapsulated pleural effusion on the right side, and local pleural invasion cannot be excluded
.
Swollen lymph nodes in the mediastinum
.
Head CT showed multiple brain metastases, accompanied by peripheral edema
.
3.
Pathological results: Lung penetration pathology: (upper right lung) poorly differentiated carcinoma, combined with immunohistochemistry, conforms to poorly differentiated adenocarcinoma
.
Immunohistochemistry: CgA(-), P63(-), Syn(-), TTF(+), CK5/6(-), Ki67(50%+), CK7(+), Napsina(-)
.
Genetic examination showed that there were no mutations in the detected sites of EGFR, ALK, ROS1, BRAF and KRAS
.
4.
Clinical diagnosis of left lung adenocarcinoma, multiple brain metastases
.
Stage: cT4N2M1 IV stage, negative driver gene
.
5.
Diagnosis and treatment After diagnosis and treatment: From December 6, 2018 to April 13, 2019, 6 cycles of pemetrexed 800mg d1 + cisplatin 40mg d1 q3w were given (the last 4 cycles were combined with bevacizumab 400mg)
.
From 2019-6-10 to 2019-8-13, pemetrexed 800mg monotherapy was maintained for 3 times
.
During chemotherapy, he received whole brain radiotherapy (PTV 3000cGy/10 times) due to multiple brain metastases on November 20, 2018
.
Tumor progression image 2019-12-25 Chest CT: The mass of the upper lobe of the right lung is strongly enlarged (33x87mm), adjacent to the pleura and ribs
.
2019-12-29 MR head enhancement: consideration of new metastases in the cerebellar hemispheres on both sides
.
The efficacy evaluation in December 2019 was tumor progression
.
Diagnosis and treatment process 2: The patient was undergoing single-drug carrelizumab 200mg q3w immune maintenance therapy 23 times (about 1.
5 years) from 2020-02-01 to 2021-07-04
.
Efficacy evaluation: no new distant lesions, stable disease (SD), and PS score 1 point
.
Adverse reactions: Grade I skin capillary hyperplasia (RCCEP)
.
Images during 1 year of PD-1 inhibitor treatment.
Chest CT and head MRI of patients every 3-6 months.
During 1 year of PD-1 inhibitor treatment, regular chest CT and head MRI suggest SD
.
CheckMate153 study Continuous Versus 1-Year Fixed-Duration Nivolumab in Previously Treated Advanced Non-Small-Cell Lung Cancer: CheckMate 153 The CheckMate153 study is the first randomized clinical study to evaluate the duration of PD-1 inhibitor treatment
.
The study included a total of 1,428 patients with advanced non-small cell lung cancer.
After 1 year of treatment with nivolumab, 252 effective patients continued to be divided into two groups: group A was continuous medication group (n=127) and group B was drug discontinuation Group (n=125) study results 1.
For patients with complete remission/partial remission (CR/PR), it is strongly recommended to extend the treatment time of PD-1 monoclonal antibody; 2.
For those with SD effect, prolong the survival of PD-1 monoclonal antibody treatment The benefits are limited
.
Summarizing the recommendations of relevant domestic and foreign guidelines, for patients with PD-1 inhibitors (CR/PR), it is not recommended to stop the drug at will, and the recommended use time is 2 years; for SD patients, use it for 1 year, and then extend it Time does not bring survival benefits
.
References: 1.
Waterhouse DM, Garon EB, Chandler J, et al.
Continuous Versus 1-Year Fixed-Duration Nivolumab in Previously Treated Advanced Non-Small-Cell Lung Cancer: CheckMate 153.
J Clin Oncol.
2020;38(33 ):3863-3873.
2.
Borghaei H, Paz-Ares L, Horn L, et al.
Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer.
N Engl J Med.
2015;373(17):1627- 1639.
3.
2021 version of "NCCN non-small cell lung cancer clinical diagnosis and treatment guidelines".
4.
Wu Liusheng, Liu Jixian, Wu Da, Luan Xinyu, Luo Ruixing, Hou Qinghua, Liu Linzhuang, Wu Dingwang, Xu Pengcheng, Li Xiaoqiang.
PD-1/PD- Research progress of L1 immunosuppressant in immunotherapy of non-small cell lung cancer[J].
Journal of Oncology,2021,27(09):710-715.
