AUTHOR=Chai Rong , Yin Yipengchen , Cai Xuwei , Fu Xiaolong , Zhang Qin 

TITLE=Patterns of Failure in Patients With Advanced Non-Small Cell Lung Cancer Treated With Immune Checkpoint Inhibitors

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.724722

DOI=10.3389/fonc.2021.724722

ISSN=2234-943X

ABSTRACT=Objective: The advent of immune checkpoint inhibitors (ICIs) has rapidly transformed the treatment paradigm of non-small cell lung cancer (NSCLC). Despite the durability of response to ICIs, the vast majority of patients will later develop progression. However, the failure patterns of ICIs treatment are unknown. Here, our study explored the failure patterns in advanced NSCLC patients treated with ICIs.
Methods: A cohort of 156 IIIB or IV NSCLC patients treated with first/second-line ICIs were retrospectively analyzed. Patients with clinical benefit and then developed progression were identified. The disease progression patterns were divided into 3 categories: progression in sites of “new”, progression in “existing” sites and the combined progression. The number of progression sites was also recorded. 
Results: Before cut-off date, ninety-one (77.1%) patients had experienced disease progression. 34% of patients had progressed in the last nine months of the first year. Fifty-three (58.2%) patients had developed progression at existing lesions. 56 (61.5%) patients had shown ≤2 progression sites (oligo-progression). In patients with oligo-progression, the median time of disease progression was 8.23 months and the counterpart (systemic progression) was 5.97 months. The oligo-progression patients showed the prolonged median overall survival (27.23 months) compared to systemic progression ones (18.87 months).  
Conclusions: Failure patterns of ICIs therapy were predominantly “existing” sites, and the most common lesions of progression were lung and lymph nodes. Most patients experienced oligo-progression which occurred later than systemic progression and showed prolonged overall survival. The control of the local lesions might be beneficial to improve the ICIs treatment efficacy.