Although PD-1/PD-L1 inhibitors have revolutionized advanced non-small cell lung cancer (NSCLC) treatment, systemic administration is limited by suboptimal local drug concentrations in tumors and the occurrence of immune-related adverse events (irAEs). This study aimed to evaluate the efficacy and safety of local administration of PD-1 inhibitors via bronchial artery infusion (BAI) for the treatment of NSCLC. This single-center prospective cohort study enrolled a total of 47 patients with advanced NSCLC (stage IIIB-IV) who were EGFR and ALK wild-type and exhibited poor response following 2 to 4 cycles of standard treatment. Patients were divided into BAI (n = 23) and Venous (n = 24) groups based on the route of PD-1 inhibitor administration. Both groups received PD-1 inhibitors combined with platinum-based chemotherapy. Notably, chemotherapy was administered via BAI in both groups, with the only difference being the route of PD-1 inhibitor delivery. The primary endpoints of the study was progression-free survival (PFS), and the secondary endpoints were objective response rates(ORR), disease control rates (DCR), overall survival (OS) and safety. At 6-month follow-up, higher ORR (47.8% vs. 16.7%, P = 0.026) and DCR were observed in the BAI group compared to the Venous group (73.9% vs. 41.6%, P = 0.014). The BAI cohort was associated with longer median PFS (11.1 vs. 6.6 months; HR = 0.372, 95% CI: 0.150-0.919; P = 0.030), with a trend toward improved OS (17.9 vs. 15.2 months, P = 0.085). Multivariable analysis identified BAI administration (HR = 0.372, P = 0.032) and younger age (HR = 2.838, P = 0.039) as independent predictors of prolonged PFS. No grade 3-4 treatment-related adverse events were observed in either group of patients. Immune-related pneumonitis (grade 1-2) occurred in 4.3% of patients in the BAI group and 4.2% in the venous group. Due to the limited sample size, a statistical comparison between groups was not performed. All adverse events were manageable with appropriate supportive treatment. BAI administration of PD-1 inhibitors was associated with improved therapeutic efficacy in advanced NSCLC, yielding longer PFS and higher ORR and DCR compared to the Venous group, without increasing severe toxicity.
Liu et al. (Tue,) studied this question.