Published 2021
| Version v1
Publication
Post-progression outcomes of NSCLC patients with PD-L1 expression ≥ 50% receiving first-line single-agent pembrolizumab in a large multicentre real-world study
Creators
- Cortellini A.
- Cannita K.
- Tiseo M.
- Cortinovis D. L.
- Aerts J. G. J. V.
- Baldessari C.
- Giusti R.
- Ferrara M. G.
- D'Argento E.
- Grossi F.
- Guida A.
- Berardi R.
- Morabito A.
- Genova C.
- Antonuzzo L.
- Mazzoni F.
- De Toma A.
- Signorelli D.
- Gelibter A.
- Targato G.
- Rastelli F.
- Chiari R.
- Rocco D.
- Gori S.
- De Tursi M.
- Mansueto G.
- Zoratto F.
- Filetti M.
- Bracarda S.
- Citarella F.
- Marco R.
- Cantini L.
- Nigro O.
- Buti S.
- Minuti G.
- Landi L.
- Ricciardi S.
- Migliorino M. R.
- Natalizio S.
- Simona C.
- De Filippis M.
- Metro G.
- Adamo V.
- Russo A.
- Spinelli G. P.
- Di Maio M.
- Banna G. L.
- Friedlaender A.
- Addeo A.
- Pinato D. J.
- Ficorella C.
- Porzio G.
Contributors
Others:
- Cortellini, A.
- Cannita, K.
- Tiseo, M.
- Cortinovis, D. L.
- Aerts, J. G. J. V.
- Baldessari, C.
- Giusti, R.
- Ferrara, M. G.
- D'Argento, E.
- Grossi, F.
- Guida, A.
- Berardi, R.
- Morabito, A.
- Genova, C.
- Antonuzzo, L.
- Mazzoni, F.
- De Toma, A.
- Signorelli, D.
- Gelibter, A.
- Targato, G.
- Rastelli, F.
- Chiari, R.
- Rocco, D.
- Gori, S.
- De Tursi, M.
- Mansueto, G.
- Zoratto, F.
- Filetti, M.
- Bracarda, S.
- Citarella, F.
- Marco, R.
- Cantini, L.
- Nigro, O.
- Buti, S.
- Minuti, G.
- Landi, L.
- Ricciardi, S.
- Migliorino, M. R.
- Natalizio, S.
- Simona, C.
- De Filippis, M.
- Metro, G.
- Adamo, V.
- Russo, A.
- Spinelli, G. P.
- Di Maio, M.
- Banna, G. L.
- Friedlaender, A.
- Addeo, A.
- Pinato, D. J.
- Ficorella, C.
- Porzio, G.
Description
Background: Treatment sequencing with first-line immunotherapy, followed by second-line chemotherapy, is still a viable option for NSCLC patients with PD-L1 expression ≥50%. Methods: We evaluated post-progression treatment pathways in a large real-world cohort of metastatic NSCLC patients with PD-L1 expression ≥ 50% treated with first-line pembrolizumab monotherapy. Results: Overall, 974 patients were included. With a median follow-up of 22.7 months (95%CI: 21.6–38.2), the median overall survival (OS) of the entire population was 15.8 months (95%CI: 13.5–17.5; 548 events). At the data cutoff, among the 678 patients who experienced disease progression, 379 (55.9%) had not received any further treatment, and 359 patients (52.9%) had died. Patients who did not receive post-progression therapies were older (p = 0.0011), with a worse ECOG-PS (p < 0.0001) and were on corticosteroids prior to pembrolizumab (p = 0.0024). At disease progression, 198 patients (29.2%) received a switched approach and 101 (14.9%) received pembrolizumab ByPD either alone (64 [9.4%]) or in combination with local ablative treatments (37 [5.5%]) (LATs). After a random-case control matching according to ECOG-PS, CNS metastases, bone metastases, and (previous) best response to pembrolizumab, patients receiving pembrolizumab ByPD plus LATs were confirmed to have a significantly longer post-progression OS compared to patients receiving pembrolizumab ByPD alone 13.9 months versus 7.8 months (p = 0.0179) 241 patients (35.5%) among the 678 who had experienced PD, received a second-line systemic treatment (regardless of previous treatment beyond PD). As compared to first-line treatment commencement, patients' features at the moment of second-line initiation showed a significantly higher proportion of patients aged under 70 years (p = 0.0244), with a poorer ECOG-PS (p < 0.0001) and having CNS (p = 0.0001), bone (p = 0.0266) and liver metastases (p = 0.0148). Conclusions: In the real-world scenario NSCLC patients with PD-L1 expression ≥50% treated with first-line single-agent pembrolizumab achieve worse outcomes as compared to the Keynote-024 trial. Poor post-progression outcomes are major determinants of the global results that should be considered when counselling patients for first-line treatment choices.
Additional details
Identifiers
- URL
- http://hdl.handle.net/11567/1073068
- URN
- urn:oai:iris.unige.it:11567/1073068
Origin repository
- Origin repository
- UNIGE