Antitumor effect of immune checkpoint inhibitor for subsequent therapy

Abstract

Abstract Background The pathway consisting of the receptor programmed cell death 1 (PD-1) and its ligands plays a crucial role to escape T cell-mediated immunity. Antibodies targeting PD-1 and its ligands have beneficial antitumor effects on many cancers, and some cases show long-time survival. Methods We retrospectively reviewed medical records of non-small cell lung cancer (NSCLC), head and neck cancer, and renal cancer patients who received subsequent therapy (chemotherapy or targeted therapy) after the administration of anti PD-1 or PD-L1 antibody between January 2016 and December 2018 at Okazaki City Hospital. Subsequent therapy included S-1, Pemetrexed (PEM), Cisplatin (CDDP) +PEM +Bevacizumab (BV) and PEM +BV maintenance, Carboplatin (CBDCA) +PEM and PEM maintenance, weekly Paclitaxel (wPTX), Docetaxel (DTX), Everolimus and Pazopanib. The latest analysis was performed in June 2019. Results Of the 13 patients who had received anti PD-1 antibody (NSCLC/head and neck cancer/renal cancer, 7/3/3; Nivolumab/Pembrolizumab, 10/3), 2 had partial response and 7 had stable disease for the 1st line subsequent therapy (overall response rate, 15%; disease control rate, 69%). Duration of median progression free survival (PFS) at the therapy was 10.9 m (S-1 in NSCLC), 16.0 m (CDDP+PEM+BV and PEM+BV maintenance), NE (PEM), 6.2 m (CBDCA+ PEM and PEM maintenance), 5.0 m (wPTX), 0.5 m (DTX), 6.0 m (Everolimus) and 14.1 m (Pazopanib) each. Median overall survival was 14.0 m, and 7 of the 13 patients were still alive. Two patients with Grade 2 interstitial lung disease due to Everolimus and PEM were successfully treated. Conclusion PFS of S-1 in NSCLC after the administration of anti PD-1 antibody was longer than that of the East Asia S-1 Trial in Lung Cancer. Interstitial lung disease due to targeted therapy was successfully managed.