晚期胃癌不必折騰PD-1抗體免疫治療了

來自專欄基於基因組學診斷的癌症靶向治療

免疫治療如果沒有比常規化療效果更好，就沒有必要去多花這個冤枉錢去折騰了。

剛剛柳葉刀雜誌發表了多國30個中心的大規模3期臨床試驗，看看PD-1抗體治療晚期胃癌是否效果優於化療，結果令人失望。

Findings： Between June 4, 2015, and July 26, 2016, 592 patients were enrolled. Of the 395 patients who had a PD-L1 CPS of 1 or higher, 196 patients were assigned to receive pembrolizumab and 199 patients were assigned to receive paclitaxel.

As of Oct 26, 2017, 326 patients in the population with CPS of 1 or higher had died (151 [77%] of 196 patients in the pembrolizumab group and 175 [88%] of 199 patients in the paclitaxel group). Median overall survival was 9·1 months

(95% CI 6·2–10·7) with pembrolizumab and 8·3 months (7·6–9·0) with paclitaxel (hazard ratio [HR] 0·82, 95% CI 0·66–1·03; one-sided p=0·0421). Median progression-free survival was 1·5 months (95% CI 1·4–2·0) with pembrolizumab and 4·1 months (3·1–4·2) with paclitaxel (HR 1·27, 95% CI 1·03–1·57). In the total population, grade 3–5 treatment related adverse events occurred in 42 (14%) of the 294 patients treated with pembrolizumab and 96 (35%) of the 276 patients treated with paclitaxel.

中位生存期免疫治療比二線化療長24天， 無進展生存期比二線化療短兩個半月。無進展生存期的圖如下所示， 紅線是化療，藍線是免疫治療。

所以不要盲目相信免疫治療是抗癌神器， 至少對於晚期胃癌，免疫治療並沒有那麼好的效果， 就不要勞民傷財的去折騰了。