Background/objective: Carboplatin, pemetrexed, and pembrolizumab are established as a key first-line regimen for metastatic non-small cell lung cancer, although selecting the optimal therapy for each patient remains challenging in real-world clinical practice. This retrospective multicenter study compared the efficacy and safety of two atezolizumab-based combination regimens, ACnP (carboplatin, nab-paclitaxel, atezolizumab) and ABCP (carboplatin, paclitaxel, bevacizumab, atezolizumab), in patients with non-small cell lung cancer in real-world clinical practice. Methods: A total of 91 patients treated between May 2018 and December 2023 at six Japanese hospitals were analyzed: 40 received ACnP and 51 received ABCP. Patient characteristics, treatment outcomes, and adverse events were compared, with subgroup analyses adjusted by inverse probability of treatment weighting using propensity scores. Results: The objective response rates were 55.0% with ACnP and 45.1% with ABCP. Median progression-free survival was 5.5 months for ACnP and 6.9 months for ABCP, while median overall survival was 16.2 and 18.3 months, respectively. Subgroup analyses showed significantly improved progression-free survival with ABCP in patients with brain metastases, liver metastases, EGFR-positive tumors, PD-L1-positive tumors, and impaired renal function (CCr < 45 mL/min). ABCP also conferred overall survival benefits in patients with brain and liver metastases. However, ACnP was associated with a lower incidence of neutropenia, peripheral neuropathy, and skin rash. Conclusions: These findings suggest that ABCP may offer superior efficacy in specific non-small cell lung cancer subgroups, while ACnP remains a valuable option for patients requiring a more tolerable safety profile.
背景/目的：卡铂、培美曲塞和帕博利珠单抗已成为转移性非小细胞肺癌的关键一线治疗方案，但在真实世界临床实践中，为每位患者选择最佳疗法仍具挑战性。这项回顾性多中心研究比较了两种基于阿替利珠单抗的联合方案——ACnP（卡铂、白蛋白结合型紫杉醇、阿替利珠单抗）与ABCP（卡铂、紫杉醇、贝伐珠单抗、阿替利珠单抗）在真实世界临床实践中治疗非小细胞肺癌患者的疗效与安全性。方法：分析了2018年5月至2023年12月期间在日本六家医院接受治疗的91例患者：其中40例接受ACnP方案，51例接受ABCP方案。比较了患者特征、治疗结果和不良事件，并采用倾向评分逆概率加权法进行亚组分析调整。结果：ACnP组的客观缓解率为55.0%，ABCP组为45.1%。ACnP组的中位无进展生存期为5.5个月，ABCP组为6.9个月；中位总生存期分别为16.2个月和18.3个月。亚组分析显示，在脑转移、肝转移、EGFR阳性肿瘤、PD-L1阳性肿瘤及肾功能不全（肌酐清除率<45 mL/min）患者中，ABCP方案的无进展生存期显著改善。对于脑转移和肝转移患者，ABCP方案还带来了总生存获益。然而，ACnP方案的中性粒细胞减少、周围神经病变和皮疹发生率较低。结论：这些研究结果表明，ABCP方案可能在特定非小细胞肺癌亚组中具有更优疗效，而ACnP方案对于需要更佳安全耐受性的患者仍是重要选择。
肿瘤(癌症)患者之家