Clinical efficacy analysis of cross-line immunotherapy in driver gene-negative advanced non-small cell lung cancer patients

WANG Yuankun; LU Jiahao; HU Jing; XIE Conghua

doi:10.12173/j.issn.1004-5511.202408043

Abstract：Objective To investigate the clinical efficacy and prognosis of cross-line immunotherapy for driver gene-negative advanced non-small cell lung cancer(NSCLC).Methods Clinical data of patients with advanced NSCLC in Zhongnan Hospital of Wuhan University from June 2019 to December 2023 were retrospectively analyzed.For first-line treatment for the patients,programmed cell death receptor-1(PD-1)monoclonal antibody combined with platinum-based doublet chemotherapy was adopted,and for second-line treatment,PD-1 monoclonal antibody combined with chemotherapy was used.The Kaplan-Meier method was employed to draw survival curves,and the Log-rank test was used to evaluate the differences in survival.The Cox proportional hazards regression model was used to analyze the risk factors that affect prognosis and subgroup analyses were conducted to explore the impact on patients'prognosis.Results A total of 112 advanced NSCLC patients with negative driver genes were included.The overall response rate(ORR)of cross-line immunotherapy was 20.54％,and the disease control rate(DCR)of cross-line immunotherapy reached 49.11％.The median overall survival(OS)was 26.6 months.The median progression free survival of first-line treatment(PFS-1)was 7.3 months,and that of second-line treatment(PFS-2)was 5.4 months.The subgroup analysis showed that,compared with patients with PFS-1≤10 months,patients with PFS-1＞10 months had longer median OS[44.3 months vs.13.8 months,P＜0.001]and median PFS-2[10.0 months vs.3.5 months,P＜0.01].Patients with BMI＞25 kg/m2 had longer median PFS-2 than those with BMI≤25 kg/m2[10.0 months vs.4.2 months,P＜0.05].Moreover,in contrast to patients with low expression of PD-L1(＜1％PD-L1 on tumor cells or tissues),patients with high expression of PD-L1 had a longer median PFS-2[6.9 months vs.2.5 months,P＜0.01].In the multivariate Cox proportional hazards regression analysis,compared with patients with PFS-1≤10 months,patients with PFS-1＞10 months had a 52％reduction in the risk of progression[HR=0.48,95％CI(0.27,0.87),P＜0.05].Conclusion The benefits of cross-line immunotherapy might not be remarkable for advanced non-small cell lung cancer with negative driver genes.However,patients with PFS-1＞10 months may have a better prognosis.