Immunotherapy Outcomes in Individuals with Non-Small Cell Lung Cancer and Poor Performance Status
Menée dans un contexte de vie réelle auprès de patients atteints d'un cancer du poumon non à petites cellules de stade IV et d'un statut de faible performance (statut ECOG supérieur ou égal à 2), cette étude analyse l'effet, sur la survie, d'une immunothérapie de première ligne, avec ou sans chimiothérapie, selon le statut tumoral de PD-1/PD-L1
Background : Patients with NSCLC treated in real-world practice typically have worse performance status (PS) compared to clinical trial patients and the effectiveness of immunotherapy in this population in unknown. In this study we assessed the effectiveness of standard of care immunotherapy for the first line treatment of stage IV patients with NSCLC with ECOG PS ≥ 2. Methods : We selected ECOG PS ≥ 2 patients from real-world oncology data from a de-identified database and included them if they were diagnosed with stage IV NSCLC and had documented PD-(L)1 expression > 0. Patients with tumor PD-(L)L1 expression ≥50% treated with pembrolizumab monotherapy were compared to those who did not have any documented treatment. Patients with tumor PD-(L)L1 expression <50% treated with pembrolizumab and chemotherapy were compared to those treated with pembrolizumab monotherapy and those without documented treatment. Results : In our propensity score adjusted analysis, patients with ECOG PS ≥ 2 and tumor PD-(L)L1 expression ≥50% treated with pembrolizumab monotherapy had statistically significantly better real world overall survival compared to those without documented treatment (adjusted HR = 0.39; 95% Confidence Internal[CI] =0.32–0.47). For patients with tumor PD-(L)1 expression <50%, there was also a statistically significant rwOS benefit for those who received treatment, either with combination pembrolizumab plus chemotherapy (adjusted HR = 0.39, 95% CI = 0.32–0.46) or pembrolizumab monotherapy (adjusted HR = 0.55, 95% CI = 0.41–0.70), compared to patients receiving no documented treatment. Conclusions : Among a highly representative sample of patients with advanced NSCLC and poor performance status, our findings suggest that immunotherapy may provide an important survival benefit in individuals with high PD-(L)1 expressing tumors, and in conjunction with chemotherapy in tumors with low PD-(L)1 expression.
JNCI Cancer Spectrum 2022