İmmün kontrol noktası inhibitörü alan hastalarda kemik koruycu ajanların kullanımı ile sağ kalım arasındaki ilişki

Abstract

Giriş: Kemik metastazlarının yönetimi kanser hastaları için çok önemlidir. Bu çalışmanın amacı, immün kontrol noktası inhibitörleri (ICI) ile tedavi edilen hastalarda sağkalım sonuçları ile kemik koruyucu ajan (BMA) kullanımı arasındaki ilişkiyi değerlendirmektir. Method: Bu çalışmaya, Ocak 2018 ile Aralık 2023 arasında en az 3 doz ICI alan ve ICI tedavisine başlanıldığı esnada kemik metastazı olan hastalar dahil edilmiştir. Hastalar ait olan kanser tipi, spesifik immünoterapi tedavisi ve aldıkları BMA'larla ilgili bilgiler de dahil olmak üzere bütün veriler retrospektif olarak hastane kayıt sisteminden elde edilmiştir. Bulgular: 142 hasta çalışmaya dahil edilmiştir. Ortanca takip süresi 36 [Çeyrekler arası aralık (IQR)=18-50] ay ve BMA'ların başlanmasından son kontrole kadar olan ortanca takip süresi 14 aydı (IQR=5-29). Çok değişkenli analizlerde yaş, cinsiyet, ‘’Eastern Cooperative Oncology Group Scale ‘’(ECOG) skoru ve önceki tedavi sayısı için ayarlama yapıldığında, BMA kullanmayan hastalarda genel sağkalım süresinin daha kısa olduğu görülmüştür. (HR: 2.30, %95CI: 1.03-2.45; p=0.036). Ayrıca, BMA kullanımının 24 aya eşit veya daha uzun sağkalım olarak tanımlanan uzun dönem fayda ile ilişkili olduğu görülmüştür. (HR: 2.85, %95CI 1.13-7.21; p=0.027). Sonuç: Kemik koruyucu ajanların kullanılmasının, ICI ile tedavi edilen ve kemik metastazı olan hastalarda genel sağkalımın bağımsız bir belirleyicisi olabileceği bulunmuştur. Bu bulgu, klinisyenleri kemik metastazları tespit edildikten sonra mümkün olan en kısa sürede BMA'lara başlamaya yönlendirebilir.

Keywords

• İmmün kontrol noktası inhibitörleri
• denosumab
• zoledronik asit
• sağkalım
• uzun dönem fayda

Bone-modifying agents and survival in patients treated with immune checkpoint inhibitors

Abstract

Aims: Management of bone metastasis is crucial for cancer patients. The objective of this study was to assess the correlation between survival outcomes and bone-modifying agents (BMAs) in patients treated with immune checkpoint inhibitors (ICIs). Methods: This study was conducted in individuals who received at least 3 doses of ICIs between January 2018 and December 2023 and had bone metastases at initiation of ICIs. We retrospectively collected data on each patient from their medical records, including information on cancer, the specific immunotherapy treatment, and the BMAs they were receiving. Results: 142 patients were included. The median follow-up was 36 [interquartile range (IQR)=18-50] months and the median follow-up from the initiation of BMAs to the last control was 14 months (IQR=5-29). After adjustment for age, gender, Eastern Cooperative Oncology Group (ECOG) score and number of prior treatment lines in the multivariate analyses, patients who did not use BMAs had decreased overall survival (OS) (HR: 2.30, 95%CI: 1.03-2.45; p=0.036). In addition, BMAs use was associated with long-term benefit defined as having a survival of equal to or longer than 24 months (HR: 2.85, 95%CI 1.13-7.21; p=0.027). Conclusion: It was found that using BMAs could be an independent predictor of OS in patients treated with ICI and who had bone metastasis. This finding may lead clinicians to start BMAs as soon as possible after bone metastases are detected.

Keywords

• Immune checkpoint inhibitors
• denosumab
• zoledronic acid
• survival
• long-term benefit

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