Nicht-kleinzelliges Lungenkarzinom

Die Fortschritte in der Behandlung des nicht-kleinzelligen Lungenkarzinoms (NSCLC) betreffen nicht nur neue Therapieregime, sondern auch bekannte Substanzen. Beim ESMO 2021 wurden Auswertungen der Studien BEVERLY und IMpower010 präsentiert, die Therapieoptionen für selektierte Patienten in der ersten Therapielinie sowie in der adjuvanten Behandlung beleuchten.

Nicht-kleinzelliges Lungenkarzinom

Mit zielgerichteten Therapien konnten beim nicht-kleinzelligen Lungenkarzinom (NSCLC) bereits vielversprechende Ergebnisse für selektierte Patienten erzielt werden. Mit der Immuntherapie, insbesondere in Kombination mit einer Chemotherapie, wurde die Prognose weiterer selektierter Patienten verbessert. Beim diesjährigen ASCO wurden tiefergehende Untersuchungen zu beiden Strategien in verschiedenen Therapielinien und Patientensubgruppen präsentiert.

Nicht kleinzelliges Lungenkarzinom: Die Rolle immunassoziierter unerwünschter Ereignisse im Hinblick auf die Prognose und Wirksamkeit bei Patienten unter Immuntherapie

<b>Purpose:</b> The development of immune-related adverse events (irAEs) in patients undergoing immunotherapy has been reported to be a favorable prognostic factor in several studies. We aimed to examine the correlation between irAEs and prognosis in patients with non-small cell lung cancer (NSCLC) and further reveal the patient characteristics associated with response to immunotherapy among treatment responders who developed irAEs. <b>Methods:</b> We retrospectively enrolled 80 patients with NSCLC who received immunotherapy at Shinshu University Hospital between February 2016 and February 2020. Progression-free survival (PFS) and overall survival (OS) were compared between patients with and those without irAEs. We examined the prognostic factors associated with PFS and OS using univariate and multivariate Cox proportional-hazards models. We further analyzed the patients who developed irAEs by classifying them into responders and non-responders. <b>Results:</b> Twenty-five patients developed irAEs. The median PFS and OS of the patients with irAEs were significantly longer than those of the patients without irAEs (6.8 vs. 1.9 months, <i>p</i> &#x3c; 0.001, and 37.8 vs. 8.1 months, <i>p</i> &#x3c; 0.001, respectively). Multivariate analysis associated with PFS and OS indicated that the development of irAEs was an independent favorable prognostic factor. Among the patients developing irAEs, the responder group had a significantly higher incidence of multiple irAEs than the non-responder group (41.7 vs. 0.0%, <i>p</i> = 0.009). <b>Conclusion:</b> Our findings revealed that the development of irAEs was associated with clinical benefits in NSCLC patients who received immunotherapy. In particular, patients with multiple irAEs might have good prognoses.

Metastasiertes nicht kleinzelliges Lungenkarzinom: Operation vor zielgerichteter Therapie mit EGFR-TKI

<b>Objectives:</b> The characteristics and efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) in advanced <i>EGFR</i>-mutant lung adenocarcinoma patients with primary tumor resection (PTR) is not yet clear. <b>Methods:</b> We enrolled advanced <i>EGFR</i>-mutant lung adenocarcinoma patients with EGFR-TKI as first-line therapy to access the impact of PTR on the outcomes. <b>Results:</b> A total of 466 patients were enrolled with 76 patients (16.3%) undergoing PTR; 59 patients recurred after curative surgery, while 17 patients underwent surgery as diagnostic purposes. PTR patients displayed a better performance status, a lower metastatic burden, and much less measurable diseases (30.3 vs. 97.4%, <i>p</i> &#x3c; 0.001). PTR patients experienced a significantly longer progression-free survival (25.1 [95% CI 16.6–33.7] vs. 9.4 [95% CI 8.4–10.4] months; aHR 0.40 [95% CI 0.30–0.54], <i>p</i> &#x3c; 0.001) and overall survival (56.8 [95% CI 36.3–77.2] vs. 31.8 [95% CI 28.2–35.4] months; aHR 0.57 [95% CI 0.39–0.84], <i>p</i> = 0.004). Survival advantage was still observed while comparing PTR patients with the better performance and lower metastatic burden subgroup found within the non-resection group. Moreover, the progression-free survival and overall survival of 11 patients who were found having pleural metastases during surgery and underwent PTR plus pleural biopsy, were also longer than those with pure N0–1/M1a-malignant pleural effusion disease in the non-resection group (<i>n</i> = 19) (<i>p</i> &#x3c; 0.001 and <i>p</i> = 0.002, respectively). <b>Conclusion:</b> PTR was associated with significantly better outcomes in advanced lung adenocarcinoma patients treated with EGFR-TKI. Further studies are needed to evaluate the biological role of PTR among these patients.

Nicht-kleinzelliges Lungenkarzinom mit MET-Veränderungen

Bei Patienten mit einem nicht-kleinzelligen Lungenkarzinom (NSCLC) mit MET-Amplifikation wird das mediane Gesamtüberleben (OS) nach bisheriger Datenlage durch Immuncheckpoint-Inhibitoren (ICI) im Vergleich zu einer Chemotherapie verlängert. Eine neue Kohortenstudie einer Kölner Arbeitsgruppe weist nun darauf hin, dass der Benefit einer ICI-Therapie nicht für NSCLC-Patienten mit einer Mutation am MET Exon 14 (METex14) besteht.