不可逆电穿孔联合化疗和 PD-1/PD-L1 阻断增强局部晚期胰腺癌的抗肿瘤免疫。
Irreversible electroporation combined with chemotherapy and PD-1/PD-L1 blockade enhanced antitumor immunity for locally advanced pancreatic cancer.
机构信息
Central Laboratory, Affiliated Fuda Cancer Hospital, Jinan University, Guangzhou, China.
Department of Oncology, Affiliated Fuda Cancer Hospital, Jinan University, Guangzhou, China.
出版信息
Front Immunol. 2023 Aug 25;14:1193040. doi: 10.3389/fimmu.2023.1193040. eCollection 2023.
BACKGROUND
Irreversible electroporation (IRE) is a novel local tumor ablation approach with the potential to stimulate an antitumor immune response. However, it is not effective in preventing distant metastasis in isolation. This study aimed to compare the potential of augmenting the antitumor immune response in patients with locally advanced pancreatic cancer (LAPC) who underwent IRE combined with chemotherapy and PD-1/PD-L1 blockade with those who underwent IRE combined with chemotherapy.
METHODS
A retrospective review was conducted on LAPC patients treated either with IRE in combination with chemotherapy and PD-1/PD-L1 blockade (group A) or with IRE with chemotherapy alone (group B) from July 2015 to June 2021. The primary outcomes were overall survival (OS) and progression-free survival (PFS), with immune responses and adverse events serving as secondary endpoints. Risk factors for OS and PFS were identified using univariate and multivariate analyses.
RESULTS
A total of 103 patients were included in the final analysis, comprising 25 in group A and 78 in group B. The median duration of follow-up was 18.2 months (3.0-38.6 months). Group A patients demonstrated improved survival compared to group B (median OS: 23.6 . 19.4 months, = 0.001; median PFS: 18.2 . 14.7 months, = 0.022). The data suggest a robust immune response in group A, while adverse events related to the treatment were similar in both groups. The multivariate analysis identified the combination of IRE, chemotherapy, and PD-1/PD-L1 blockade as an independent prognostic factor for OS and PFS.
CONCLUSION
The addition of PD-1/PD-L1 blockade to the regimen of IRE combined with chemotherapy enhanced antitumor immunity and extended survival in LAPC patients.
背景
不可逆电穿孔（IRE）是一种新的局部肿瘤消融方法，具有刺激抗肿瘤免疫反应的潜力。然而，单独使用它并不能有效预防远处转移。本研究旨在比较在接受 IRE 联合化疗和 PD-1/PD-L1 阻断的局部晚期胰腺癌（LAPC）患者与仅接受 IRE 联合化疗的患者中，增强抗肿瘤免疫反应的潜力。
方法
回顾性分析了 2015 年 7 月至 2021 年 6 月期间接受 IRE 联合化疗和 PD-1/PD-L1 阻断（A 组）或 IRE 联合化疗（B 组）治疗的 LAPC 患者。主要结局是总生存期（OS）和无进展生存期（PFS），免疫反应和不良事件为次要终点。使用单因素和多因素分析确定 OS 和 PFS 的危险因素。
结果
最终纳入 103 例患者进行分析，其中 A 组 25 例，B 组 78 例。中位随访时间为 18.2 个月（3.0-38.6 个月）。A 组患者的生存时间优于 B 组（中位 OS：23.6 个月比 19.4 个月，=0.001；中位 PFS：18.2 个月比 14.7 个月，=0.022）。数据表明 A 组有强烈的免疫反应，而两组的治疗相关不良事件相似。多因素分析表明，IRE、化疗和 PD-1/PD-L1 阻断的联合是 OS 和 PFS 的独立预后因素。
结论
在 IRE 联合化疗方案中加入 PD-1/PD-L1 阻断剂增强了 LAPC 患者的抗肿瘤免疫反应，并延长了患者的生存时间。
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