PO.CL09.02 · 临床研究

转移性非小细胞肺癌继发性中枢神经系统转移的比较风险：在TriNetX上进行的pembrolizumab与atezolizumab单药治疗的真实世界倾向性匹配分析

Comparative risk of secondary central nervous system metastases in metastatic non-small cell lung cancer: A real-world propensity-matched analysis of pembrolizumab vs atezolizumab monotherapy conducted on TriNetX

编号 6649 展板 18 时间 4/21 02:00–05:00 区域 Section 47 主讲 Umer Rizwan, BS,MA,MD

分会场 Real World Data to Provide Real World Evidence

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作者与单位 Authors & Affiliations

Umer Rizwan¹, Athar Nawab², Syed Najafi², Karandeep Bawa³, Fnu Muhibullah², Christian Kaftanic², Sunanda Tah², Sabir Hussain⁴

¹Jefferson Einstein Philadelphia Hospital, Philadelphia, WV,²Internal Medicine Residency, West Virginia University Camden Clark Medical Center, Parkersburg, WV,³West Virginia School of Osteopathic Medicine, Lewisburg, WV,⁴Hematology and Oncology, West Virginia University Camden Clark Medical Center, Parkersburg, WV

摘要 Abstract

中文摘要

背景：骨和骨髓转移显著加重转移性非小细胞肺癌（mNSCLC）的发病率。评估pembrolizumab与atezolizumab单药治疗之间骨骼转移进展的比较性真实世界数据仍然有限。方法：我们使用TriNetX美国协作网络（69家HCO）进行了一项回顾性队列分析。识别接受一线pembrolizumab或atezolizumab单药治疗的IV期mNSCLC患者。倾向性评分匹配（1:1）产生平衡队列（各n=7,768）。在治疗开始后365天内评估结局。主要终点是新发继发性骨/骨髓转移（ICD-10 C79.51、C79.52、C79.5）。既往有骨骼转移的患者被排除在结局分析之外。结果：排除后，分析了5,277例atezolizumab和5,780例pembrolizumab患者。与pembrolizumab相比，atezolizumab与显著更高的骨/骨髓转移发生率相关（16.5% vs 10.8%；RR 1.53；95% CI 1.39-1.68；p<0.001）。Kaplan-Meier分析显示atezolizumab的无转移生存期降低（79.5% vs 86.8%，Log-Rank p<0.001）。atezolizumab的转移进展风险显著更高（HR 1.62；95% CI 1.46-1.80）。atezolizumab还显示出更高的平均转移发生次数（0.93 vs 0.55；p<0.001）。结论：在这一大型真实世界匹配队列中，与pembrolizumab相比，atezolizumab单药治疗与显著更高的1年继发性骨或骨髓转移风险相关。这些发现提示各ICI之间在骨骼转移进展方面存在具有临床意义的差异，值得进一步开展前瞻性和机制性研究。

查看英文原文 English abstract

Background: Bone and bone-marrow metastases significantly worsen morbidity in metastatic non-small cell lung cancer (mNSCLC). Comparative real-world data assessing skeletal metastatic progression between pembrolizumab and atezolizumab monotherapy remain limited. Methods: We performed a retrospective cohort analysis using the TriNetX US Collaborative Network (69 HCOs). Stage IV mNSCLC patients treated with first-line pembrolizumab or atezolizumab monotherapy were identified. Propensity score matching (1:1) produced balanced cohorts (n=7,768 each). Outcomes were assessed over 365 days following treatment initiation. The primary endpoint was new-onset secondary bone/bone-marrow metastases (ICD-10 C79.51, C79.52, C79.5). Patients with prior skeletal metastases were excluded from outcome analyses. Results: Following exclusions, 5,277 atezolizumab and 5,780 pembrolizumab patients were analyzed. Atezolizumab was associated with a significantly higher incidence of bone/bone-marrow metastases compared with pembrolizumab (16.5% vs 10.8%; RR 1.53; 95% CI 1.39-1.68; p<0.001). Kaplan-Meier analysis demonstrated reduced metastasis-free survival with atezolizumab (79.5% vs 86.8%, Log-Rank p<0.001). Hazard of metastatic progression was significantly higher with atezolizumab (HR 1.62; 95% CI 1.46-1.80). Atezolizumab also demonstrated a greater mean number of metastatic instances (0.93 vs 0.55; p<0.001). Conclusions: In this large real-world matched cohort, atezolizumab monotherapy was associated with a significantly greater 1-year risk of secondary bone or bone-marrow metastases compared with pembrolizumab. These findings suggest clinically meaningful differences in skeletal metastatic progression between ICIs and warrant further prospective and mechanistic investigation.

利益披露 Disclosure

U. Rizwan, None.. A. Nawab, None.. S. Najafi, None.. K. Bawa, None.. F. Muhibullah, None.. C. Kaftanic, None.. S. Tah, None.. S. Hussain, None.

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