文章：

真实世界视角下度伐利尤单抗对III期不可切除非小细胞肺癌影响的叙事性综述

Real-World Insights into the Impact of Durvalumab on Stage III Unresectable Non-Small Cell Lung Cancer—A Narrative Review

原文发布日期：3 March 2025

DOI: 10.3390/cancers17050874

类型: Article

开放获取: 是

英文摘要：

Introduction and Aim: Stage III Non-Small Cell Lung Cancer (NSCLC) has a poor prognosis, with median survival ranging from 9 to 34 months. The PACIFIC trial demonstrated that durvalumab after platinum-based chemoradiotherapy (CRT) improves overall survival (OS) and progression-free survival (PFS). This review evaluates real-world evidence (RWE) on durvalumab’s efficacy and safety, focusing on patient characteristics, prognostic factors, treatment protocols, and outcomes beyond progression. Materials and Methods: A literature search of PubMed, Embase, and Google Scholar identified 49 observational studies published from January 2017 to August 2024 on unresectable stage III NSCLC. Clinical trials, early-stage disease, and alternative treatments were excluded. Results: Compared to the PACIFIC trial, real-world patients were older, had poorer ECOG performance (≥2), and more comorbidities like COPD. Despite this, durvalumab provided consistent survival benefits. Positive prognostic factors included non-squamous histology, high PD-L1 expression, and timely durvalumab initiation (≤42 days post-CRT). Most radiotherapy regimens mirrored PACIFIC (54–66 Gy). Concomitant CRT was used in 90% of cases, with sequential CRT for frail patients. Chemotherapy regimens varied. Immune-mediated pneumonitis was a major adverse event, with incidence rates between 15% and 100%. Severe cases led to treatment discontinuation, impacting survival. Treatment beyond progression remains uncertain, with limited benefits from immunotherapy rechallenge. Conclusions: RWE supports durvalumab’s efficacy, emphasizing the need for personalized treatment strategies and further research to improve long-term outcomes.

摘要翻译： 

引言与目的：III期非小细胞肺癌（NSCLC）预后较差，中位生存期仅为9至34个月。PACIFIC试验证实，铂类放化疗（CRT）后使用度伐利尤单抗可改善患者总生存期（OS）和无进展生存期（PFS）。本综述通过真实世界证据（RWE）评估度伐利尤单抗的疗效与安全性，重点关注患者特征、预后因素、治疗方案及进展后治疗策略。材料与方法：通过检索PubMed、Embase和Google Scholar数据库，筛选出2017年1月至2024年8月发表的49项针对不可切除III期NSCLC的观察性研究，排除临床试验、早期疾病研究及其他治疗方案相关文献。结果：与PACIFIC试验相比，真实世界患者年龄更大、ECOG体能状态更差（≥2分）、合并症（如慢性阻塞性肺疾病）更多。尽管如此，度伐利尤单抗仍展现出稳定的生存获益。阳性预后因素包括非鳞状组织学类型、高PD-L1表达水平以及及时启动度伐利尤单抗治疗（CRT后≤42天）。多数放疗方案与PACIFIC试验一致（54–66 Gy），90%病例采用同步放化疗，体弱患者则采用序贯放化疗。化疗方案存在差异。免疫介导性肺炎是主要不良事件，发生率在15%至100%之间，严重病例需终止治疗并影响生存。进展后治疗方案尚不明确，免疫治疗再挑战的获益有限。结论：真实世界证据支持度伐利尤单抗的临床疗效，强调需制定个体化治疗策略并开展进一步研究以改善长期预后。

原文链接：

Real-World Insights into the Impact of Durvalumab on Stage III Unresectable Non-Small Cell Lung Cancer—A Narrative Review