PMID- 36386462
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221118
IS  - 2218-6751 (Print)
IS  - 2226-4477 (Electronic)
IS  - 2218-6751 (Linking)
VI  - 11
IP  - 10
DP  - 2022 Oct
TI  - The efficacy and safety of immune checkpoint inhibitors combined with 
      chemotherapy or anti-angiogenic therapy as a second-line or later treatment 
      option for advanced non-small cell lung cancer: a retrospective comparative 
      cohort study.
PG  - 2111-2124
LID - 10.21037/tlcr-22-697 [doi]
AB  - BACKGROUND: Although immune checkpoint inhibitor (ICI) monotherapy remains the 
      standard of second-line treatment for patients with advanced non-small cell lung 
      cancer (NSCLC) , the objective response rate (ORR) is low. There is an urgent 
      need to increase the response population of second-line immunotherapy, and ICI 
      combination therapy may be a possible option. However, the evidence is 
      insufficient. METHODS: We retrospectively collected the medical records of 
      patients who received ICI monotherapy or ICI combination therapy as a second-line 
      or later treatment option. We further analysed baseline clinical characteristics, 
      evaluated treatment efficacy, assessed treatment-related adverse events (AEs) and 
      followed up survival. The outcome variables assessed in the study were ORR, 
      disease control rate (DCR), progression-free survival (PFS), overall survival 
      (OS) and AEs. RESULTS: A total of 145 patients were ultimately enrolled in this 
      study, including the ICI monotherapy group (n=63) and ICI combination therapy 
      group (n=82). The ICI combination therapy group was further divided into the 
      ICI/chemotherapy group (n=57) and ICI/anti-angiogenic therapy group (n=25). The 
      baseline was comparable among the three subgroups. The ICI combination therapy 
      groups showed a higher ORR (29.3% vs. 11.1%, P=0.008) and DCR (85.4% vs. 61.9%, 
      P=0.001) and a longer PFS (6.77 vs. 3.47 months, P<0.001) and OS (18.60 vs. 8.47 
      months, P<0.001) than the ICI monotherapy group. The ICI/chemotherapy group 
      showed a significantly higher ORR (31.6% vs. 11.1%, P=0.006) and DCR (84.2% vs. 
      61.9%, P=0.006) and a longer PFS (6.37 vs. 3.47 months, P<0.001) and OS (18.60 
      vs. 8.47 months, P<0.001) than the ICI monotherapy group. The ICI/anti-angiogenic 
      therapy group showed a significantly higher DCR (88.0% vs. 61.9%, P=0.021) and a 
      longer PFS (8.17 vs. 3.47 months, P<0.001) and OS (19.20 vs. 8.47 months, 
      P=0.005) than the ICI monotherapy group. Neither of the combined ICI therapy 
      groups showed a significant increase in the incidence of AEs compared to the ICI 
      monotherapy group. CONCLUSIONS: ICI combined with chemotherapy or anti-angiogenic 
      therapy as second-line or later treatment demonstrated superiority over ICI 
      monotherapy in advanced NSCLC patients without prior immunotherapy. These results 
      provide a potentially superior treatment strategy and require verification in 
      prospective clinical trials.
CI  - 2022 Translational Lung Cancer Research. All rights reserved.
FAU - Chen, Bolin
AU  - Chen B
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Wang, Jingyi
AU  - Wang J
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Pu, Xingxiang
AU  - Pu X
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Li, Jia
AU  - Li J
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Wang, Qianzhi
AU  - Wang Q
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Liu, Liyu
AU  - Liu L
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Xu, Yan
AU  - Xu Y
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Xu, Li
AU  - Xu L
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Kong, Yi
AU  - Kong Y
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Li, Kang
AU  - Li K
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Xu, Fang
AU  - Xu F
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Liang, Shuzhi
AU  - Liang S
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
FAU - Cardona, Andres F
AU  - Cardona AF
AD  - Foundation for Clinical and Applied Cancer Research-FICMAC, Bogota, Colombia.
AD  - Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el 
      Bosque, Bogota, Colombia.
AD  - Direction of Research and Education, Luis Carlos Sarmiento Angulo Cancer 
      Treatment and Research Cencer-CTIC, Bogota, Colombia.
FAU - Wu, Lin
AU  - Wu L
AD  - The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated 
      Cancer Hospital of Xiangya School of Medicine, Central South University, 
      Changsha, China.
LA  - eng
PT  - Journal Article
PL  - China
TA  - Transl Lung Cancer Res
JT  - Translational lung cancer research
JID - 101646875
PMC - PMC9641046
OTO - NOTNLM
OT  - Immune checkpoint inhibitors (ICIs)
OT  - anti-angiogenic therapy
OT  - chemotherapy
OT  - combined modality therapy
OT  - non-small cell lung cancer (NSCLC)
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://tlcr.amegroups.com/article/view/10.21037/tlcr-22-697/coif). LW reports 
      that this research was funded by the Wu Jieping Medical Foundation (No. 
      320.6750.19088-11), the Health Research Foundation of Chinese Society of Clinical 
      Oncology (No. Y-2019Genecast-024), the Hunan Cancer Hospital Climb plan (No. 
      ZX2020005-5), and the Hunan Provincial Natural Science Foundation of China (No. 
      2021JJ30430). LW also received personal fees from AstraZeneca, Roche, 
      Bristol-Myers Squibb, MSD, Pfizer, Lilly, Boehringer Ingelheim, Merck, Innovent, 
      and Hengrui, outside the submitted work. The other authors have no conflicts of 
      interest to declare.
EDAT- 2022/11/18 06:00
MHDA- 2022/11/18 06:01
PMCR- 2022/10/01
CRDT- 2022/11/17 11:44
PHST- 2022/07/16 00:00 [received]
PHST- 2022/10/19 00:00 [accepted]
PHST- 2022/11/17 11:44 [entrez]
PHST- 2022/11/18 06:00 [pubmed]
PHST- 2022/11/18 06:01 [medline]
PHST- 2022/10/01 00:00 [pmc-release]
AID - tlcr-11-10-2111 [pii]
AID - 10.21037/tlcr-22-697 [doi]
PST - ppublish
SO  - Transl Lung Cancer Res. 2022 Oct;11(10):2111-2124. doi: 10.21037/tlcr-22-697.