《肿瘤学年鉴》：首次发现！PD-L1高表达晚期非锯齿肺癌患者，用免疫单药治疗就够了

wPFS在病患的前几个同年下降较快，随着等待时间的推移，两一组的椭圆促使靠近。这说明， 在PD-L1低表达出来的病患里，CIT-chemo在延缓最初重大突破方面可能优于CIT-mono，但不时会增加依然获利。而且， CIT-chemo和CIT-mono两个一组的最初重大突破者比例（3个同年内发生PFS事件）完全相同，计有20%和17%（P=0.48）。

CIT-chemo一组和CIT-mono一组的里位PFS

A：总老年人；B：根据针灸特质划分亚一组；C：根据有害史开展分一组

以上结果表明，对于PD-L1低表达出来的Nsq-NSCLC病患，CIT-mono和CIT-chemo的里位OS和rwPFS从未歧异，远比较是在存在预后不当的分散，如脑或肝分散的病患里也是如此。仅仅仅仅在小一小从来不有害的病患里，CIT-chemo比CIT-mono获利更加多。

与化学治疗远比，致病病患的毒副作用比较比较大，虽然致病单药病患可以避免化学治疗的毒副作用， 但如果病患对致病病患从未反应，则可能时会增加癌最初重大突破的风险。据既往的几项NSCLC的针灸试验刊文，与化学治疗远比，致病单药病患一组存在一一小发生最初重大突破和死亡的病患[7, 8]。因此， 针灸外科医生要及时评估病患对致病病患的反应，尽快下一步病患设计方案——继续致病单药病患还是协同化学治疗。

参考文献：

[1] Planchard, D., S. Popat, K. Kerr, et al., Metastatic non-small cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018, 29(Suppl 4): iv192-iv237.

[2] Borghaei, H., L. Paz-Ares, L. Horn, et al., Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer. N Engl J Med. 2015, 373(17): 1627-1639.

[3] Herbst, R.S., P. Baas, D.W. Kim, et al., Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. 2016, 387(10027): 1540-1550.

[4] Paz-Ares, L., D. Vicente, A. Tafreshi, et al., A Randomized, Placebo-Controlled Trial of Pembrolizumab Plus Chemotherapy in Patients With Metastatic Squamous NSCLC: Protocol-Specified Final Analysis of KEYNOTE-407. J Thorac Oncol. 2020, 15(10): 1657-1669.

[5] Gadgeel, S., D. Rodríguez-Abreu, G. Speranza, et al., Updated Analysis From KEYNOTE-189: Pembrolizumab or Placebo Plus Pemetrexed and Platinum for Previously Untreated Metastatic Nonsquamous Non-Small-Cell Lung Cancer. J Clin Oncol. 2020, 38(14): 1505-1517.

[6] Perol, M., E. Felip, U. Dafni, et al., Effectiveness of PD-(L)1 inhibitors alone or in combination with platinum-doublet chemotherapy in first-line (1L) non-squamous non-small-cell lung cancer (Nsq-NSCLC) with PD-L1-high expression using real-world data. Ann Oncol. 2022.

[7] Mok, T.S.K., Y.L. Wu, I. Kudaba, et al., Pembrolizumab versus chemotherapy for previously untreated, PD-L1-expressing, locally advanced or metastatic non-small-cell lung cancer (KEYNOTE-042): a randomised, open-label, controlled, phase 3 trial. Lancet. 2019, 393(10183): 1819-1830.

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