Efficacy And Safety Analysis Of PD-1 Inhibitors In Combination With Chemotherapy For Postoperative Recurrent Non-Small Cell Lung Cancer

Objective: Programmed death receptor 1(PD-1)inhibitors have been recommended in several studies as first-line therapeutic agents for patients with advanced non-small cell lung cancer(NSCLC)without epidermal growth factor receptor(EGFR)mutations or anaplastic lymphoma kinase(ALK)gene fusions,but their efficacy and safety as treatment for postoperative relapsed NSCLC is unknown.As an extremely promising novel therapeutic agent,PD-1 inhibitors offer a new treatment option for postoperative recurrence of lung cancer.The aim of this study was to evaluate the efficacy(progression-free survival,objective remission rate,disease control rate,etc.)and safety(incidence of adverse events)of combined immunotherapy with PD-1 inhibitors in patients with postoperative recurrence of non-small cell lung cancer.Methods: Patients with NSCLC who underwent radical lung cancer surgery with postoperative recurrence from June 2017 to March 2022 at Zhong da Hospital,Southeast University were retrospectively analyzed,and patients were divided into immunotherapy and non-immunotherapy groups according to whether they were treated with a combination of PD-1 inhibitors after recurrence.Patients were assessed for remission using RECIST1.1;median progression-free survival and median overall survival were counted using the K-M method;univariate and multifactorial analyses were performed using Cox regression models for variables that might affect survival;and treatment-related adverse events were evaluated and recorded.Results: A total of 33 patients were enrolled,including 23 in the combined immunotherapy group and 10 in the non-immunotherapy group.13 patients(56.5%)in the combined immunotherapy group experienced adverse reactions during immunotherapy combined with chemotherapy,which was not significantly different from 6 cases(60%)in the non-immunotherapy group.One patient in the combined immunotherapy group developed grade 3 immune-associated pneumonia,which recovered after treatment with systemic corticosteroids,and no adverse events were seen subsequently.Other adverse events were milder and the duration of discomfort was shorter.The objective remission rate(ORR)between the two groups was 34.8% vs 10%(P=0.217),disease control rate(DCR)was 82.6% vs 40%(P=0.035),median progression-free survival(PFS)was 6.94 months vs 3.0 months(HR 0.35,95% CI: 0.14-0.88,P=0.020),and combined median survival was not reached in the immunotherapy group.Conclusion: In the postoperative recurrence population of non-small cell lung cancer,combination PD-1 inhibitors resulted in better remission rates and progression-free survival with no significant increase in the incidence of adverse events compared with conventional chemotherapy.It is recommended to be used along with close monitoring of immune-related adverse effects.