Chemotherapy in non-small cell lung cancer patients after prior immunotherapy: The multicenter retrospective CLARITY study
Menée en Italie à partir de données portant sur 342 patients atteints d'un cancer du poumon non à petites cellules de stade avancé, cette étude rétrospective évalue l'efficacité, du point de vue de la survie globale, et la toxicité d'une chimiothérapie de sauvetage après l'échec d'une immunothérapie
Objectives : In the most of cases, for non-small cell lung cancer (NSCLC) patients who progressedto previous immune checkpoint inhibitors (CKI) administered as first- or as second-linetherapy, chemotherapy (CT) remains the only viable options in the absence of “druggable” mutations. We aimed to explore the efficacy of salvage chemotherapy after immunotherapy(SCAI) in advanced NSCLC patients. Materials and Methods : We designed a retrospective, multicenter study, involving 20 Italian centers, withthe primary objective of describing the clinical outcome of advanced NSCLC patientstreated with SCAI at the participating institutions from November 2013 to July 2019.The primary endpoint of the study was represented by overall survival (OS), definedas the time from CT initiation to death. Secondary outcome endpoints of the SCAI (progressionfree survival, PFS, objective response rate, ORR and toxicity) and explorative biomarkers(lactate dehydrogenase, LDH, and neutrophil-to-lymphocyte ratio, NLR during immunotherapy)were also analyzed. Results : In our study population of 342 NSCLC patients, SCAI obtained a median OS of 6.8 months(95 % confidence interval, CI 5.5–8.1), median PFS of 4.1 months (95 % CI 3.4−4.8)and ORR of 22.8 %. A “Post-CKI score” was constructed by combining significant predictorsof OS at the multivariate analyses (sex, ECOG PS, disease control with prior immunotherapy),Harrell’C was 0.65, (95 % CI:0.59−0.71). Conclusions : Despite the late-line settings, our findings support the hypothesis that previousimmunotherapy might increase the sensitivity of the tumor to the subsequent chemotherapy.The “Post-CKI score” was clinically effective in successfully discriminating threedistinct prognostic subgroups of patients after the failure of CKI, representing apossibly useful tool for the tailored decision-making process of advanced treatment-linesettings in NSCLC.
Lung Cancer 2020