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Real-world outcomes of anti-PD1 antibodies in platinum-refractory, PD-L1-positive recurrent and/or metastatic non-small cell lung cancer, and its potential practical predictors: first report from Korean Cancer Study Group LU19-05

Authors
 Ji Hyun Park  ;  Gun Lyung You  ;  Myung-Ju Ahn  ;  Sang-We Kim  ;  Min Hee Hong  ;  Ji-Youn Han  ;  Chan-Young Ock  ;  Jong-Seok Lee  ;  In Jae Oh  ;  Shin Yup Lee  ;  Cheol Hyeon Kim  ;  Young Joo Min  ;  Yoon Hee Choi  ;  Jeong-Seon Ryu  ;  Sun Hyo Park  ;  Hee Kyung Ahn  ;  Byoung-Yong Shim  ;  Ki Hyeong Lee  ;  Sung Yong Lee  ;  Jin-Soo Kim  ;  Jiun Yi  ;  Su Kyung Choi  ;  Hyonggin An  ;  Jin Hyoung Kang 
Citation
 JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY, Vol.147(8) : 2459-2469, 2021-08 
Journal Title
JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY
ISSN
 0171-5216 
Issue Date
2021-08
MeSH
Aged ; Aged, 80 and over ; Antibodies, Monoclonal / therapeutic use ; Antibodies, Monoclonal, Humanized / therapeutic use ; Antineoplastic Agents, Immunological / therapeutic use* ; B7-H1 Antigen / genetics ; B7-H1 Antigen / metabolism ; Carcinoma, Non-Small-Cell Lung / drug therapy* ; Carcinoma, Non-Small-Cell Lung / genetics ; Carcinoma, Non-Small-Cell Lung / mortality ; Carcinoma, Non-Small-Cell Lung / pathology ; Cisplatin / therapeutic use* ; Drug Resistance, Neoplasm* / drug effects ; Female ; Humans ; Lung Neoplasms / drug therapy* ; Lung Neoplasms / genetics ; Lung Neoplasms / mortality ; Lung Neoplasms / pathology ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local / diagnosis ; Neoplasm Recurrence, Local / genetics ; Neoplasm Recurrence, Local / metabolism ; Nivolumab / therapeutic use ; Prognosis ; Programmed Cell Death 1 Receptor / immunology* ; Republic of Korea / epidemiology ; Survival Analysis ; Treatment Outcome
Keywords
Biomarkers ; Immune-checkpoint inhibitor ; Non-small cell lung cancer ; PD-L1 ; Real-world ; irAE
Abstract
Purpose: Although immune-checkpoint inhibitors have become a new therapeutic option for recurrent/metastatic non-small cell lung cancers (R/M-NSCLC), its clinical benefit in the real-world is still unclear.

Methods: We investigated 1181 Korean patients with programmed death-1 ligand 1 (PD-L1)-positive [tumor proportion score (TPS) ≥ 10% by the SP263 assay or ≥ 50% by the 22C3 assay] R/M-NSCLC treated with pembrolizumab or nivolumab after failure of platinum-based chemotherapy.

Results: The median age was 67 years, 13% of patients had ECOG-PS ≥ 2, and 27% were never-smokers. Adenocarcinoma was predominant (61%) and 18.1% harbored an EGFR activating mutation or ALK rearrangement. Pembrolizumab and nivolumab were administered to 51.3% and 48.7, respectively, and 42% received them beyond the third-line chemotherapy. Objective response rate (ORR) was 28.6%. Pembrolizumab group showed numerically higher ORR (30.7%) than the nivolumab group (26.4%), but it was comparable with that of the nivolumab group having PD-L1 TPS ≥ 50% (32.4%). Median progression-free survival (PFS) and overall survival (OS) were 2.9 (95% CI 0-27.9) and 10.7 months (95% CI 0-28.2), respectively. In multivariable analysis, concordance of TPS ≥ 50% in both PD-L1 assays and the development of immune-related adverse events (irAEs) were two significant predictors of better ORR, PFS, and OS. EGFR mutation could also predict significantly worse OS outcomes.

Conclusion: The real-world benefit of later-line anti-PD1 antibodies was comparable to clinical trials in patients with R/M-NSCLC, although patients generally were more heavily pretreated and had poorer ECOG-PS. Concordantly high PD-L1 TPS ≥ 50% and development of irAE could independently predict better treatment outcomes, while EGFR mutation negatively affected OS.
Full Text
https://link.springer.com/article/10.1007%2Fs00432-021-03527-4
DOI
10.1007/s00432-021-03527-4
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Hong, Min Hee(홍민희) ORCID logo https://orcid.org/0000-0003-3490-2195
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184868
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