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Patterns of Failure in Metastatic NSCLC Treated With First Line Pembrolizumab and Use of Local Therapy in Patients With Oligoprogression.
Friedes, Cole; Yegya-Raman, Nikhil; Zhang, Siqi; Iocolano, Michelle; Cohen, Roger B; Aggarwal, Charu; Thompson, Jeffrey C; Marmarelis, Melina E; Levin, William P; Cengel, Keith A; Ciunci, Christine A; Singh, Aditi P; D'Avella, Christopher; Davis, Christiana W; Langer, Corey J; Feigenberg, Steven J.
Afiliación
  • Friedes C; Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: cole.friedes@pennmedicine.upenn.edu.
  • Yegya-Raman N; Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Zhang S; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
  • Iocolano M; Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Cohen RB; Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Aggarwal C; Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Thompson JC; Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
  • Marmarelis ME; Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Levin WP; Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Cengel KA; Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Ciunci CA; Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Singh AP; Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • D'Avella C; Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Davis CW; Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Langer CJ; Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Feigenberg SJ; Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Clin Lung Cancer ; 25(1): 50-60.e6, 2024 01.
Article en En | MEDLINE | ID: mdl-37813713
INTRODUCTION: The patterns of failure (POF) for metastatic non-small-cell lung cancer (mNSCLC) treated with immunotherapy are not well established. METHODS: We conducted a retrospective cohort study of mNSCLC that received first-line pembrolizumab with or without chemotherapy at a single academic center from 2015 to 2021. We defined POF with 2 classifications: 1) local, regional, or distant failure, or 2) failure in existing lesions, new lesions, or a combination. Oligoprogression was defined as disease progression (PD) in ≤3 sites of failure. Overall survival (OS) was measured via Kaplan-Meier and modelled with Cox regression. RESULTS: Of 298 patients identified, 198 had PD. Using POF classification 1, most failures were distant (43.9%) or a combination of locoregional and distant (34.4%). For POF classification 2, failures occurred in a combination of new and existing lesions (45.0%), existing lesions alone (33.3%), or in new lesions only (21.7%). Oligoprogression occurred in 39.9% (n = 79) cases. Median OS was higher in the following: PD in existing lesions vs. new or new + existing lesions (28.7 vs. 20.2 vs. 13.9 months, P < .001) and oligoprogression vs. polyprogression (35.1 vs. 12.2 months, P < .001). In oligoprogression, median OS was better for those who received radiation to all sites of PD (62.2 months) than for those who changed systemic therapy (22.9 months, P = .007). On multivariable analysis, radiation for oligoprogression (HR 0.35, 95% CI: 0.20-0.62, P < .001) was associated with improved OS. CONCLUSIONS: In mNSCLC treated with pembrolizumab, oligoprogression is relatively common. Randomized data are needed to define the benefits of radiation in oligoprogressive mNSCLC.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Carcinoma de Pulmón de Células no Pequeñas / Neoplasias Pulmonares Tipo de estudio: Clinical_trials / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Clin Lung Cancer Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Carcinoma de Pulmón de Células no Pequeñas / Neoplasias Pulmonares Tipo de estudio: Clinical_trials / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Clin Lung Cancer Asunto de la revista: NEOPLASIAS Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos