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Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC
Background: Studies have shown that aggressive treatment of non-small cell lung cancer (NSCLC) with oligometastatic disease improves the overall survival (OS) compared to a palliative approach and some immunotherapy checkpoint inhibitors, such as anti-programmed cell death ligand 1 (PD-L1), anti-pro...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924378/ https://www.ncbi.nlm.nih.gov/pubmed/33498159 http://dx.doi.org/10.3390/curroncol28010059 |
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author | Gauvin, Camille Krishnan, Vimal Kaci, Imane Tran-Thanh, Danh Bédard, Karine Albadine, Roula Leduc, Charles Gaboury, Louis Blais, Normand Tehfe, Mustapha Routy, Bertrand Florescu, Marie |
author_facet | Gauvin, Camille Krishnan, Vimal Kaci, Imane Tran-Thanh, Danh Bédard, Karine Albadine, Roula Leduc, Charles Gaboury, Louis Blais, Normand Tehfe, Mustapha Routy, Bertrand Florescu, Marie |
author_sort | Gauvin, Camille |
collection | PubMed |
description | Background: Studies have shown that aggressive treatment of non-small cell lung cancer (NSCLC) with oligometastatic disease improves the overall survival (OS) compared to a palliative approach and some immunotherapy checkpoint inhibitors, such as anti-programmed cell death ligand 1 (PD-L1), anti-programmed cell death protein 1 (PD-1), and T-Lymphocyte-associated antigen 4 (CTLA-4) inhibitors are now part of the standard of care for advanced NSCLC. However, the prognostic impact of PD-L1 expression in the oligometastatic setting remains unknown. Methods: Patients with oligometastatic NSCLC were identified from the patient database of the Centre hospitalier de l’Université de Montréal (CHUM). “Oligometastatic disease” definition chosen is one synchronous metastasis based on the M1b staging of the eight IASLC (The International Association for the Study of Lung Cancer) Classification (within sixth months of diagnosis) or up to three cerebral metastasis based on the methodology of the previous major phase II randomized study of Gomez et al. We compared the OS between patients receiving aggressive treatment at both metastatic and primary sites (Group A) and patients receiving non-aggressive treatment (Group B). Subgroup analysis was performed using tumor PD-L1 expression. Results: Among 643 metastatic NSCLC patients, we identified 67 patients with oligometastasis (10%). Median follow-up was 13.3 months. Twenty-nine patients (43%) received radical treatment at metastatic and primary sites (Group A), and 38 patients (57%) received non-aggressive treatment (Group B). The median OS (mOS) of Group A was significantly longer than for Group B (26 months vs. 5 months, p = 0.0001). Median progression-free survival (mPFS) of Group A was superior than Group B (17.5 months vs. 3.4 months, p = 0.0001). This difference was still significant when controlled for primary tumor staging: stage I (p = 0.316), stage II (p = 0.024), and stage III (p = 0.001). In the cohort of patients who were not treated with PD-L1 inhibitors, PD-L1 expression negatively correlated with mOS. Conclusions: Aggressive treatments of oligometastatic NSCLC significantly improve mOS and mPFS compared to a more palliative approach. PD-L1 expression is a negative prognostic factor which suggests a possible role for immunotherapy in this setting. |
format | Online Article Text |
id | pubmed-7924378 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-79243782021-03-03 Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC Gauvin, Camille Krishnan, Vimal Kaci, Imane Tran-Thanh, Danh Bédard, Karine Albadine, Roula Leduc, Charles Gaboury, Louis Blais, Normand Tehfe, Mustapha Routy, Bertrand Florescu, Marie Curr Oncol Article Background: Studies have shown that aggressive treatment of non-small cell lung cancer (NSCLC) with oligometastatic disease improves the overall survival (OS) compared to a palliative approach and some immunotherapy checkpoint inhibitors, such as anti-programmed cell death ligand 1 (PD-L1), anti-programmed cell death protein 1 (PD-1), and T-Lymphocyte-associated antigen 4 (CTLA-4) inhibitors are now part of the standard of care for advanced NSCLC. However, the prognostic impact of PD-L1 expression in the oligometastatic setting remains unknown. Methods: Patients with oligometastatic NSCLC were identified from the patient database of the Centre hospitalier de l’Université de Montréal (CHUM). “Oligometastatic disease” definition chosen is one synchronous metastasis based on the M1b staging of the eight IASLC (The International Association for the Study of Lung Cancer) Classification (within sixth months of diagnosis) or up to three cerebral metastasis based on the methodology of the previous major phase II randomized study of Gomez et al. We compared the OS between patients receiving aggressive treatment at both metastatic and primary sites (Group A) and patients receiving non-aggressive treatment (Group B). Subgroup analysis was performed using tumor PD-L1 expression. Results: Among 643 metastatic NSCLC patients, we identified 67 patients with oligometastasis (10%). Median follow-up was 13.3 months. Twenty-nine patients (43%) received radical treatment at metastatic and primary sites (Group A), and 38 patients (57%) received non-aggressive treatment (Group B). The median OS (mOS) of Group A was significantly longer than for Group B (26 months vs. 5 months, p = 0.0001). Median progression-free survival (mPFS) of Group A was superior than Group B (17.5 months vs. 3.4 months, p = 0.0001). This difference was still significant when controlled for primary tumor staging: stage I (p = 0.316), stage II (p = 0.024), and stage III (p = 0.001). In the cohort of patients who were not treated with PD-L1 inhibitors, PD-L1 expression negatively correlated with mOS. Conclusions: Aggressive treatments of oligometastatic NSCLC significantly improve mOS and mPFS compared to a more palliative approach. PD-L1 expression is a negative prognostic factor which suggests a possible role for immunotherapy in this setting. MDPI 2021-01-20 /pmc/articles/PMC7924378/ /pubmed/33498159 http://dx.doi.org/10.3390/curroncol28010059 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Gauvin, Camille Krishnan, Vimal Kaci, Imane Tran-Thanh, Danh Bédard, Karine Albadine, Roula Leduc, Charles Gaboury, Louis Blais, Normand Tehfe, Mustapha Routy, Bertrand Florescu, Marie Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC |
title | Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC |
title_full | Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC |
title_fullStr | Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC |
title_full_unstemmed | Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC |
title_short | Survival Impact of Aggressive Treatment and PD-L1 Expression in Oligometastatic NSCLC |
title_sort | survival impact of aggressive treatment and pd-l1 expression in oligometastatic nsclc |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924378/ https://www.ncbi.nlm.nih.gov/pubmed/33498159 http://dx.doi.org/10.3390/curroncol28010059 |
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