医学
阿替唑单抗
培美曲塞
贝伐单抗
卡铂
肿瘤科
内科学
顺铂
化疗
癌症
彭布罗利珠单抗
免疫疗法
作者
Tai Chung Lam,Kwt Tsang,H.C. Choi,V.H. Lee,Ka-On Lam,Chi‐Lu Chiang,Tsz Him So,Wendy Chan,S.F. Nyaw,Farah Louise Lim,James Siu Ki Lau,Jeannie Yin Kwan Chik,F.M. Kong,A.W. Lee
出处
期刊:Lung Cancer
[Elsevier]
日期:2021-09-01
卷期号:159: 18-26
被引量:50
标识
DOI:10.1016/j.lungcan.2021.07.004
摘要
Abstract
Introduction
Acquired resistance to TKI is an important unmet need in the management of EGFR mutated lung cancer. Recent clinical trial IMPower150 suggested that combination approach with VEGF inhibitor, check point inhibitor immunotherapy and platinum-based chemotherapy was effective in oncogene driven lung cancer. The current trial examined the efficacy of a modified regimen in an EGFR mutated cohort. Methods
An open-labelled, single arm, phase II study was conducted in patients with EGFR mutated NSCLC who had progressed on at least one EGFR TKI. For those with T790M mutation, radiological progression on osimertinib was required for enrolment. Patients were treated with combination atezolizumab (1200 mg), bevacizumab (7.5 mg/kg), pemetrexed (500 mg/m2) and carboplatin (AUC 5) given once every 3 weeks until progression. Results
Forty patients were enrolled. Median age was 62 (range 45–76) years. More than one half (23/40, 57.5%) had progressed on osimertinib. PD-L1 expression was < 1% in 52.5%. Median follow-up time was 17.8 months. ORR was 62.5%. Median PFS was 9.4 months (95% CI: 7.6 – 12.1). One year OS was 72.5% (95% CI: 0.56–0.83). Treatment related grade 3 or above adverse events (AE) occurred in 37.5% (15/40). Immune-related AE occurred in 32.5% (13/40) patients. Quality of life measures of function and symptoms did not change significantly throughout the course of treatments. Post-trial rechallenge with EGFR TKI containing regimen resulted in PFS of 5.8 months (95% CI 3.9–10.0 months). Conclusion
Combination approach of atezolizumab, bevacizumab, pemetrexed and carboplatin achieved promising efficacy in metastatic EGFR mutated NSCLC after TKI failure. The results were comparable with taxane based regimen of IMPower150 while toxicity profile was improved.
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