Outcomes to first-line pembrolizumab in patients with PD-L1-high (≥50%) non-small cell lung cancer and a poor performance status Journal Article

   


Authors: Alessi, J. V.; Ricciuti, B.; Jiménez-Aguilar, E.; Hong, F.; Wei, Z.; Nishino, M.; Plodkowski, A. J.; Sawan, P.; Luo, J.; Rizvi, H.; Carter, B. W.; Heymach, J. V.; Altan, M.; Hellmann, M.; Awad, M.
Article Title: Outcomes to first-line pembrolizumab in patients with PD-L1-high (≥50%) non-small cell lung cancer and a poor performance status
Abstract: Background Patients with non-small cell lung cancer (NSCLC) and a poor Eastern Cooperative Oncology Group Performance Status (ECOG PS) have been excluded from phase III immunotherapy clinical trials. We sought to evaluate clinical outcomes to first-line pembrolizumab in patients with advanced NSCLC, a PD-L1 Tumor Proportion Score (TPS) of ≥50%, and an ECOG PS of 2. Methods We performed a multicenter retrospective analysis of patients with metastatic NSCLC and a PD-L1 TPS of ≥50% (negative for genomic alterations in EGFR and ALK) who received treatment with first-line pembrolizumab. Clinical outcomes were compared in patients based on ECOG PS. Results Among the 234 patients, 83.3% (n=195) had an ECOG PS of 0 or 1, and 16.7% (n=39) had an ECOG PS of 2. The baseline clinicopathological characteristics were balanced between the ECOG PS 0-1 vs 2 groups in terms of age, sex, tobacco use, histology, KRAS mutation status, presence of other potentially targetable driver mutations (BRAF, MET, HER2, RET), presence of brain metastases, and PD-L1 TPS distribution. Compared with patients with an ECOG PS of 0 or 1, patients with an ECOG PS of 2 had a significantly lower objective response rate (43.1% vs 25.6%; p=0.04), a numerically shorter median progression-free survival (6.6 months vs 4.0 months; HR 0.70 (95% CI 0.47 to 1.06); p=0.09), and a significantly shorter median overall survival (20.3 months vs 7.4 months; HR 0.42 (95% CI 0.26 to 0.68); p<0.001). On disease progression, patients with an ECOG PS of 2 were significantly less likely to receive second-line systemic therapy compared with patients with an ECOG PS of 0-1 (65% vs 22.2%, p=0.001). Conclusions A subset of patients with NSCLC and an ECOG PS of 2 can respond to first-line pembrolizumab. However, clinical outcomes in this population are often poor and use of second-line systemic therapy is infrequent. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Keywords: lung neoplasms; immunotherapy; tumor biomarkers
Journal Title: Journal for ImmunoTherapy of Cancer
Volume: 8
Issue: 2
ISSN: 2051-1426
Publisher: Biomed Central Ltd  
Date Published: 2020-07-01
Start Page: e001007
Language: English
DOI: 10.1136/jitc-2020-001007
PUBMED: 32753547
PROVIDER: scopus
PMCID: PMC7406027
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85089132461&doi=10.1136%2fjitc-2020-001007&partnerID=40&md5=c42c0afb4a274a43f70634e0597c5c55
Notes: Article -- Export Date: 1 September 2020 -- Source: Scopus
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MSK Authors
  1. Matthew David Hellmann
    412 Hellmann
  2. Andrew Joseph Plodkowski
    115 Plodkowski
  3. Hira Abbas Rizvi
    123 Rizvi
  4. Peter Sawan
    20 Sawan
  5. Jia Luo
    27 Luo
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