Efficacy and safety of combining anti-angiogenic therapy, radiotherapy, and PD-1 inhibitors in patients with driver gene-negative non-small cell lung cancer brain metastases: a retrospective study

• Published in: BMC cancer 2024-12, Vol.24 (1), p.1492-13, Article 1492
• Main Authors: Zhang, Xianwen, Sun, Qian, Chen, Rujun, Zhao, MengDie, Cai, Feng, Cui, Zhen, Jiang, Hao
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angiogenesis; Angiogenesis inhibitors; Angiogenesis Inhibitors - adverse effects; Angiogenesis Inhibitors - therapeutic use; Anti-angiogenic therapy; Apoptosis; Blood-brain barrier; Brain; Brain cancer; Brain metastases; Brain Neoplasms - drug therapy; Brain Neoplasms - radiotherapy; Brain Neoplasms - secondary; Cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - genetics; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Care and treatment; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; Chemotherapy; Combination therapy; Complications and side effects; Development and progression; Diagnosis; Disease; Dosage and administration; Drugs; Female; Genes; Genetic aspects; Health aspects; Hemorrhage; Humans; Immune Checkpoint Inhibitors - adverse effects; Immune Checkpoint Inhibitors - therapeutic use; Kinases; Lung cancer; Lung cancer, Non-small cell; Lung cancer, Small cell; Lung Neoplasms - drug therapy; Lung Neoplasms - genetics; Lung Neoplasms - pathology; Male; Medical prognosis; Metastases; Metastasis; Middle Aged; Mutation; Nervous system; Non-small cell lung cancer; Non-small cell lung carcinoma; Normal distribution; Oncology, Experimental; Patient outcomes; Patients; PD-1 protein; Programmed Cell Death 1 Receptor - antagonists & inhibitors; Programmed death factor-1 inhibitors; Quality of life; Radiation therapy; Radiotherapy; Response rates; Retrospective Studies; Small cell lung carcinoma; Software; Surgery; Tomography; Treatment Outcome; Vascular endothelial growth factor
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-024-13264-9

The efficacy and safety of anti-angiogenic combination therapy in patients with driver gene-negative non-small cell lung cancer (NSCLC) with brain metastases (BM) are uncertain. Eighty-eight records of driver gene-negative patients with NSCLC treated with craniocerebral radiotherapy (RT) and programmed death factor-1 (PD-1) inhibitors between May 2021 and May 2023 were collected. Based on whether anti-angiogenic therapy (AT) is combined or not, patients are categorized into the AT group and the non anti-angiogenic therapy (NAT) group. The NAT group patients received craniocerebral RT and PD-1 inhibitor and those in the AT group received craniocerebral RT and PD-1 inhibitor with ≥ 4 cycles of AT. Comparing the clinical efficacy and safety in these two patient cohorts was the main goal of the study. By May 1, 2024, the iORR was 94.0% and 63.2% for AT and NAT group, respectively. The 1- and 2-year iLPFS for AT and NAT group were 93.6%, 80.9% and 69.7%, 36.4%, respectively. The 1- and 2-year iDPFS were 86.7%, 56.3% and 59.1%, 48.3%, respectively. The 1- and 2-year OS were 82.0%, 36.6% and 68.4%, 34.6%, respectively. Compared to the standard treatment (RT and PD-1 inhibitors), the addition of AT prolonged the median iLPFS (NR vs. 22.0 months, hazard ratio [HR] = 11.004, P