Comparison of immune checkpoint inhibitor plus chemotherapy or ipilimumab plus nivolumab-based therapy for NSCLC patients with PD-L1 TPS (1%–49%): TOPGAN2023-01
Menée à partir de données portant 401 patients atteints d'un cancer du poumon non à petites cellules surexprimant PD-L1 (score de proportion tumorale entre 1 et 49 %), cette étude rétrospective multicentrique compare l'efficacité, du point de vue de la survie globale et de la survie sans progression, d'un traitement combinant inhibiteur de point de contrôle immunitaire et chimiothérapie et d'un traitement combinant ipilimumab et nivolumab
Introduction: Immune checkpoint inhibitors (ICIs) plus chemotherapy is now a standard treatment for non-small cell lung cancer (NSCLC). Whether ICI plus chemotherapy (ICI-chemo) or ipilimumab plus nivolumab (I-N)-based therapy is superior for patients with NSCLC with a programmed death-ligand 1 (PD-L1) tumor proportion score (TPS) of 1%–49% has not been evaluated. Methods: This multicenter retrospective study included NSCLC patients with a TPS score of 1%–49%, who began first-line chemotherapy. Propensity score matching analysis was used to adjust for various confounders and evaluate treatment efficacy. Results: A total of 401 patients were enrolled, of whom 308 received ICI-chemo and 93 received I-N-based therapy. The median OS was 21.0 months in the ICI-chemo group and 20.0 months in the I-N-based therapy group. After propensity score matching, there was no difference in OS or PFS between the ICI-chemo group and the I-N-based therapy group (OS: hazard ratios (HR), 0.83; 95% confidence interval [CI], 0.54–1.26, PFS: HR, 0.72; 95% CI, 0.52–1.00). Among PD-L1 TPS 25%–49%, there was a tendency for OS to be favorable for the ICI-chemo group (OS: HR, 0.30; 95% CI, 0.09–0.85). Treatment discontinuation occurred for 26.2% of the patients in the ICI-chemo group and 41.9% in the I-N-based therapy group. Conclusions: Among PD-L1 TPS 1%–49%, there was no significant difference in survival outcomes between the ICI-chemo group and the I-N-based therapy group. Based on the results of a subgroup analysis, ICI-chemo may be superior for treating NSCLC with a TPS of 25%–49%.