Purpose: We report a 10-year experience in cancer therapy with concomitant treatment of percutaneous thermal ablation (PTA) and immune checkpoint blockers (ICBs). Material and methods: This retrospective cohort study included all patients at a single tertiary cancer center who had received ICBs at most 90 days before, or 30 days after, PTA. Feasibility and safety were assessed as the primary outcomes. The procedure-related complications and immune-related adverse events (irAEs) were categorized according to the Common Terminology Criteria for Adverse Events v5.0 (CTCAE). Efficacy was evaluated based on overall survival (OS), progression-free survival (PFS), and local progression-free survival (LPFS) according to the indication, ablation modality, neoplasm histology, and ICB type. Results: Between 2010 and 2021, 78 patients (57% male; median age: 61 years) were included. The PTA modality was predominantly cryoablation (CA) (61%), followed by radiofrequency ablation (RFA) (31%). PTA indications were the treatment of oligo-persistence (29%), oligo-progression (14%), and palliation of symptomatic lesions or prevention of skeletal-related events (SREs) (56%). Most patients received anti-PD1 ICB monotherapy with pembrolizumab (n= 35) or nivolumab (n= 24). The feasibility was excellent, with all combined treatment performed and completed as planned. Ten patients (13%) experienced procedure-related complications (90% grade 1–2), and 34 patients (44%) experienced an irAE (86% grade 1–2). The only factor statistically associated with better OS and PFS was the ablation indication, favoring oligo-persistence (p= 0.02). Tumor response was suggestive of an abscopal effect in four patients (5%). Conclusions: The concomitant treatment of PTA and ICBs within 2–4 weeks is feasible and safe for both palliative and local control indications. Overall, PTA outcomes were found to be similar to standards for patients not on ICB therapy. While a consistently reproducible abscopal effect remains elusive, the safety profile of concomitant therapy provides the framework for continued assessment as ICB therapies evolve.
目的：本文报告了经皮热消融（PTA）与免疫检查点抑制剂（ICBs）联合治疗癌症的十年经验。材料与方法：这项回顾性队列研究纳入了某三级癌症中心所有在PTA前最多90天或PTA后30天内接受过ICBs治疗的患者。研究主要评估了联合治疗的可行性和安全性。根据不良事件通用术语标准v5.0（CTCAE）对操作相关并发症和免疫相关不良事件（irAEs）进行分类。疗效评估基于总生存期（OS）、无进展生存期（PFS）和局部无进展生存期（LPFS），并根据适应症、消融方式、肿瘤组织学类型和ICB类型进行分析。结果：2010年至2021年间，共纳入78例患者（男性占57%；中位年龄61岁）。PTA方式主要为冷冻消融（CA）（61%），其次是射频消融（RFA）（31%）。PTA的适应症包括寡残留治疗（29%）、寡进展治疗（14%）以及缓解症状性病灶或预防骨骼相关事件（SREs）（56%）。大多数患者接受了抗PD1 ICB单药治疗，包括帕博利珠单抗（n=35）或纳武利尤单抗（n=24）。联合治疗的可行性极佳，所有治疗均按计划完成。10例患者（13%）出现操作相关并发症（90%为1-2级），34例患者（44%）出现irAEs（86%为1-2级）。唯一与更好OS和PFS显著相关的因素是消融适应症，其中寡残留治疗患者预后更佳（p=0.02）。4例患者（5%）的肿瘤反应提示存在远隔效应。结论：在2-4周内联合应用PTA和ICBs对于姑息治疗和局部控制适应症均是可行且安全的。总体而言，PTA的疗效与未接受ICB治疗患者的标准疗效相似。尽管持续可复现的远隔效应仍难以实现，但联合治疗的安全性为ICB疗法发展过程中的持续评估提供了基础框架。
Thermal Ablation Combined with Immune Checkpoint Blockers: A 10-Year Monocentric Experience
肿瘤(癌症)患者之家