Abstract
PurposeConsidering the limited data, we aimed to identify the greatest immune activation irradiated site of common metastases and response to immune checkpoint inhibitors simultaneously in non-small cell lung cancer (NSCLC).MethodsA total of 136 patients with advanced NSCLC who had received radiation to a primary or metastatic solid tumor were enrolled. We recorded blood cell counts in three time periods, before, during, and after radiotherapy (RT), and derived some blood index ratios including monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). The delta-IBs were calculated as medio-IBs ÷ pre-IBs − 1. We analyzed the changes before and during RT using Spearman rank correlation test, Kruskal–Wallis rank sum test, and logistic regression analyzing their correlation with efficacy.ResultsThe medians of delta-MLR and delta-PLR were both the lowest while the median of delta-L was the highest in brain. Therapeutic effect evaluation showed that the objective response rate (ORR) of 48.65% (18/37) in the brain irradiation group was the highest, compared with 17.07% (7/41) in bone and 41.94% (13/31) in lung.ConclusionsIn this study, results suggested that irradiation to brain has the best immune activation effect and patient outcome compared with other organs in NSCLC, and when the earlier-line ICIs were combined with RT, a better patient outcome was reached. Prospective studies are also necessary to provide more convincing evidence and standards for clinical irradiation metastases selection.
Highlights
Advanced NSCLC is the most common pathological type in lung cancer with a 5-year survival rate of less than 5% [1]
The purpose of this study is to figure out the greatest immune activation effect among different irradiated sites during immunotherapy, so as to provide more beneficial clinical options for advanced NSCLC patients
Clinical baseline characteristics of the 136 patients enrolled are summarized in Table 1, which were divided into 6 groups according to different irradiated organs, namely, brain, bone, lung with or without drainage area lymph node, liver, adrenal gland(s), and soft tissue
Summary
Advanced NSCLC is the most common pathological type in lung cancer with a 5-year survival rate of less than 5% [1]. After the great success of targeted therapy, immune checkpoint inhibitors (ICIs) mainly targeting programmed cell death receptor-1 (PD-1)/ programmed cell death receptor-ligand 1 (PD-L1) have shown great survival improvement in advanced NSCLC in recent years [2]. The facilitation of augmenting immunotherapy includes increasing the release of tumor antigens and T-cell infiltration and enhancing antigen presentation [3]. Stereotactic body radiation therapy (SBRT) is a novel mode of radiotherapy that achieves local control rate range from 70% to 90% compared with conventionally fractionated radiotherapy (CFRT) especially in early-stage and oligometastatic NSCLC patients [8,9,10]. There is little study related to the specific number and localization of irradiated lesions for advanced NSCLC patients with multiple metastases, which should be considered as stratification factors [11]
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