文章：

早期免疫检查点抑制剂给药增加接受放化疗的III期不可切除非小细胞肺癌患者放射性肺炎风险

Early Immune Checkpoint Inhibitor Administration Increases the Risk of Radiation-Induced Pneumonitis in Patients with Stage III Unresectable NSCLC Undergoing Chemoradiotherapy

原文发布日期：20 May 2025

DOI: 10.3390/cancers17101711

类型: Article

开放获取: 是

英文摘要：

Background/Objectives: The PACIFIC trial showed that immune checkpoint inhibitors (ICI) administered after concurrent chemoradiotherapy (cCRT) significantly improve survival in stage III unresectable non-small cell lung cancer (NSCLC). However, the optimal timing of ICI administration with cCRT is still debated, with concerns about increased risks of adverse effects, particularly radiation-induced pneumonitis (RP), from combining radiotherapy and immunotherapy. Methods: A search of multiple databases identified studies on stage III unresectable NSCLC patients receiving cCRT and ICI. A meta-analysis was performed utilizing the meta package in R software. Furthermore, data from 170 patients treated at Shandong Cancer Hospital and Institute between 2019 and 2023 were analyzed to assess RP following cCRT and ICI treatment. Results: The meta-analysis revealed that the incidences of ≥grade 2 RP were 25.3%, 24.3%, and 45.3% in the ICI following cCRT group, the ICI concurrent with cCRT group, and the ICI prior to cCRT group, respectively. The ICI prior to cCRT group exhibited significantly elevated rates. In the clinical retrospective study, ≥grade 2 RP was more prevalent in the ICI concurrent with cCRT group (HR: 2.258, 95% CI: 1.135–4.492,p= 0.020) and the ICI prior to cCRT group (HR: 2.843, 95% CI: 1.453–5.561,p= 0.002) compared with the ICI following cCRT group. Furthermore, a shorter interval between treatments correlates with an increased incidence of RP. Conclusions: Advancing the timing of ICI administration is associated with an increased incidence of ≥grade 2 RP following cCRT in patients with stage III unresectable NSCLC.

摘要翻译： 

背景/目的：PACIFIC试验表明，在同步放化疗（cCRT）后给予免疫检查点抑制剂（ICI）可显著改善III期不可切除非小细胞肺癌（NSCLC）患者的生存。然而，关于ICI与cCRT联合应用的最佳时机仍存争议，主要担忧放疗与免疫治疗联用可能增加不良反应风险，尤其是放射性肺炎（RP）。方法：通过检索多个数据库，筛选出针对接受cCRT联合ICI治疗的III期不可切除NSCLC患者的研究。使用R软件中的meta程序包进行荟萃分析。此外，对山东省肿瘤医院2019年至2023年间收治的170例患者数据进行分析，评估cCRT联合ICI治疗后的RP发生情况。结果：荟萃分析显示，cCRT后序贯ICI组、cCRT同步ICI组及cCRT前使用ICI组的≥2级RP发生率分别为25.3%、24.3%和45.3%，其中cCRT前使用ICI组的RP发生率显著升高。临床回顾性研究显示，与cCRT后序贯ICI组相比，cCRT同步ICI组（HR: 2.258, 95% CI: 1.135–4.492, p=0.020）和cCRT前使用ICI组（HR: 2.843, 95% CI: 1.453–5.561, p=0.002）的≥2级RP发生率更高。此外，治疗间隔时间缩短与RP发生率升高相关。结论：在III期不可切除NSCLC患者中，提前使用ICI与cCRT后≥2级RP发生率增加相关。

原文链接：

Early Immune Checkpoint Inhibitor Administration Increases the Risk of Radiation-Induced Pneumonitis in Patients with Stage III Unresectable NSCLC Undergoing Chemoradiotherapy