Post-progression outcomes of NSCLC patients with PD-L1 expression > 50% receiving first-line single-agent pembrolizumab in a large multicentre real-world study

被引：22

作者：

Cortellini, Alessio ^{[1
,2
]}

Cannita, Katia ^{[3
]}

Tiseo, Marcello ^{[4
,5
]}

Cortinovis, Diego L. ^{[6
]}

Aerts, Joachim G. J., V ^{[7
]}

Baldessari, Cinzia ^{[8
]}

Giusti, Raffaele ^{[9
]}

Ferrara, Miriam G. ^{[10
,11
]}

D'Argento, Ettore ^{[10
]}

Grossi, Francesco ^{[12
]}

Guida, Annalisa ^{[13
]}

Berardi, Rossana ^{[14
]}

Morabito, Alessandro ^{[15
]}

Genova, Carlo ^{[16
]}

Antonuzzo, Lorenzo ^{[17
]}

Mazzoni, Francesca ^{[17
]}

De Toma, Alessandro ^{[18
]}

Signorelli, Diego ^{[18
,19
]}

Gelibter, Alain ^{[20
]}

Targato, Giada ^{[21
]}

Rastelli, Francesca ^{[22
]}

Chiari, Rita ^{[23
]}

Rocco, Danilo ^{[24
]}

Gori, Stefania ^{[25
]}

De Tursi, Michele ^{[26
]}

Mansueto, Giovanni ^{[27
]}

Zoratto, Federica ^{[28
]}

Filetti, Marco ^{[9
]}

Bracarda, Sergio ^{[29
]}

Citarella, Fabrizio ^{[30
]}

Russano, Marco ^{[30
]}

Cantini, Luca ^{[7
,14
]}

Nigro, Olga ^{[31
]}

Buti, Sebastiano ^{[5
]}

Minuti, Gabriele ^{[32
]}

Landi, Lorenza ^{[32
]}

Ricciardi, Serena ^{[33
]}

Migliorino, Maria R. ^{[33
]}

Natalizio, Salvatore ^{[34
]}

Simona, Carnio ^{[35
]}

De Filippis, Marco ^{[35
]}

Metro, Giulio ^{[36
]}

Adamo, Vincenzo ^{[37
]}

Russo, Alessandro ^{[37
]}

Spinelli, Gian P. ^{[38
]}

Di Maio, Massimo ^{[39
,40
]}

Banna, Giuseppe L. ^{[41
]}

Friedlaender, Alex ^{[42
]}

Addeo, Alfredo ^{[42
]}

Pinato, David J. ^{[2
,43
]}

机构：

[1] Univ LAquila, Dept Biotechnol & Appl Clin Sci, Laquila, Italy

[2] Imperial Coll London, Hammersmith Hosp, Dept Surg & Canc, Div Canc, London, England

[3] St Salvatore Hosp, Med Oncol, Laquila, Italy

[4] Univ Parma, Dept Med & Surg, Parma, Italy

[5] Univ Hosp Parma, Med Oncol Unit, Parma, Italy

[6] Osped San Gerardo, Med Oncol, Monza, Italy

[7] Erasmus MC, Dept Pulm Dis, Rotterdam, Netherlands

[8] AOU Policlin Modena, Dipartimeto Oncol Ematol, Modena, Italy

[9] St Andrea Hosp, Med Oncolgy, Rome, Italy

[10] Fdn Policlin Univ Gemelli, Comprehens Canc Ctr, IRCCS, Rome, Italy

[11] Univ Cattolica Sacro Cuore, Dept Translat Med & Surg, Romae, Lazio, Italy

[12] Fdn IRCCS CaGranda Osped Maggiore Policlin, Med Oncol Unit, Milan, Italy

[13] Azienda Osped Santa Maria, Dept Oncol, Terni, Italy

[14] Univ Politecn Marche, Osped Riuniti Ancona, Oncol Clin, Ancona, Italy

[15] Ist Nazl Tumori, IRCCS, Thorac Med Oncol, Fdn G Pascale, Naples, Italy

[16] Osped Policlin San Martino, Lung Canc Unit, IRCCS, Genoa, Italy

[17] Careggi Univ Hosp, Dept Oncol, Florence, Italy

[18] Ist Nazl Tumori, Dept Med Oncol, Fdn IRCCS, Milan, Italy

[19] Grande Osped Metropolitano Niguarda, Niguarda Canc Ctr, Milan, Italy

[20] Sapienza Univ Rome, Policlin Umberto I, Med Oncol B, Rome, Italy

[21] Univ Hosp Santa Maria Misericordia, Dept Oncol, Udine, Italy

[22] Med Oncol, Fermo Area Vasta 4, Fermo, Italy

[23] Osped Riuniti Padova Sud Madre Teresa Calcutta, Med Oncol, Monselice, Italy

[24] Monaldi Hosp, Pneumo Oncol Unit, Naples, Italy

[25] Osped Sacro Cuore Don Calabria, IRCCS, Oncol Unit, Negrar, VR, Italy

[26] Oral & Biotechnol Sci Univ G DAnnunzio, Dept Med, Chieti, Italy

[27] Spaziani Hosp, Med Oncol, Frosinone, Italy

[28] Santa Maria Goretti Hosp, Med Oncol, Latina, Italy

[29] Azienda Osped Santa Maria Terni, Struttura Complessa Oncol Med & Traslaz, Terni, Italy

[30] Campus Biomed Univ, Med Oncol, Rome, Italy

[31] ASST Sette Laghi, Med Oncol, Varese, Italy

[32] AUSL Romagna, Dept Oncol & Hematol, Ravenna, Italy

[33] St Camillo Forlanini Hosp, Pneumo Oncol Unit, Rome, Italy

[34] Univ Modena & Raggio Emilia, Dipartimento Oncol Ematol, Modena, Italy

[35] Univ Turin, San Luigi Hosp, Dept Oncol, Orbassano, TO, Italy

[36] Azienda Osped Perugia, Dept Med Oncol, Santa Maria Misericordia Hosp, Perugia, Italy

[37] Univ Messina, AO Papardo & Dept Human Pathol, Med Oncol, Messina, Italy

[38] Univ Rome Sapienza, UOC Terr Oncol Aprilia, AUSL Latina, Aprilia, Italy

[39] Univ Turin, Dept Oncol, Turin, Italy

[40] AO Ordine Mauriziano, Med Oncol, Turin, Italy

[41] Portsmouth Hosp Univ NHS Trust, Portsmouth, Hants, England

[42] Univ Hosp Geneva, Oncol Dept, Geneva, Switzerland

[43] Univ Piemonte Orientale, Dept Translat Med, Novara, Italy

来源：

EUROPEAN JOURNAL OF CANCER | 2021年 / 148卷

关键词：

Non-small cell lung cancer; Immunotherapy; PD-L1; Pembrolizumab; Performance status; Post-progression; Radiotherapy; Radiation therapy; CELL LUNG-CANCER; IMMUNE-CHECKPOINT INHIBITORS; SALVAGE CHEMOTHERAPY; RESPONSE RATES; IMMUNOTHERAPY; RADIOTHERAPY; ASSOCIATION; ASSAYS;

D O I：

10.1016/j.ejca.2021.02.005

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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. (c) 2021 Elsevier Ltd. All rights reserved.

引用

页码：24 / 35

页数：12

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Post-progression outcomes of NSCLC patients with PD-L1 expression &gt; 50% receiving first-line single-agent pembrolizumab in a large multicentre real-world study

Post-progression outcomes of NSCLC patients with PD-L1 expression > 50% receiving first-line single-agent pembrolizumab in a large multicentre real-world study