First-line pembrolizumab in patients with advanced non-small cell lung cancer and high PD-L1 expression: real-world data from a Spanish multicenter study
Por:
Piedra, A, Martínez-Recio, S, Hernández, A, Morán, T, Arriola, E, Recuero-Borau, J, Cobo, M, Cordeiro, P, Mosquera, J, Fernández, M, García-Campelo, R, Calles, A, Alvarez, R, Zapata-García, M, Isla, D, Callejo, A, Iranzo, P, Serra-López, J, Barba, A, Sullivan, I, Felip, E, Majem, M
Publicada:
17 dic 2024
Resumen:
Introduction Pembrolizumab stands as a first-line option for patients with advanced non-small cell lung cancer (NSCLC) and high programmed death-ligand 1 (PD-L1) expression (PD-L1 >= 50%). Several factors such as antibiotic exposure, low body mass index (BMI), certain metastatic location or poor performance status may influence outcomes. Methods We conducted a multicenter retrospective analysis in a cohort of patients with advanced high PD-L1 expression NSCLC treated with first-line pembrolizumab in clinical practice. We sought to evaluate clinical outcomes according to several factors. Results Among the 494 included patients, median age was 67.29 years, 77% were male, 54% and 38% were former or current smokers, respectively; 84% had an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0-1, and 48% had a BMI of <25. 32% of patients had bone metastases, 32% brain metastases and 16% liver metastases. 35% of patients had exposure to antibiotics (AB), 44% to corticosteroids and 62% to proton pump inhibitors (PPi). With a median follow-up of 14.3 months, the median overall survival (OS) and progression-free survival (PFS) were 15.9m (95% CI 13.1 to 18.8) and 9.9m (95% CI 7.7 to 12.1), and the overall response rate (ORR) was 43%. After univariate analysis, median OS in patients with ECOG-PS 0 vs. 1 vs. 2 was 36.7m vs. 14.8m vs. 2.7m (p<0.001). Median OS in patients who received treatment with corticosteroids vs. patients without exposure was 11.4m vs. 22.3m (p<0.001). After multivariate analysis, corticosteroid exposure (HR 1.41) and ECOG-PS (HR 2.40) maintained a prognostic impact. Discussion First-line pembrolizumab outcomes in advanced high PD-L1 expression NSCLC patients could be negatively influenced by corticosteroid exposure or poor ECOG-PS.
Filiaciones:
Piedra, A:
Hosp Santa Creu i St Pau, Med Oncol Dept, Barcelona, Spain
Univ Autonoma Barcelona UAB, Dept Med, Barcelona, Spain
Martínez-Recio, S:
Hosp Santa Creu i St Pau, Med Oncol Dept, Barcelona, Spain
Hernández, A:
Hosp Univ Germans Trias i Pujol, Med Oncol Dept, ICO Badalona, Barcelona, Spain
Morán, T:
Hosp Univ Germans Trias i Pujol, Med Oncol Dept, ICO Badalona, Barcelona, Spain
Arriola, E:
Hosp del Mar, Ctr Invest Biomed Red Canc CIBERONC, Med Oncol Dept, Barcelona, Spain
Recuero-Borau, J:
Hosp del Mar, Ctr Invest Biomed Red Canc CIBERONC, Med Oncol Dept, Barcelona, Spain
Cobo, M:
Hosp Reg Univ Virgen de la Victoria IBIMA, Med Oncol Dept, Malaga, Spain
Cordeiro, P:
Complejo Hosp Univ A Coruna, Med Oncol Dept, La Coruna, Spain
Mosquera, J:
Complejo Hosp Univ A Coruna, Med Oncol Dept, La Coruna, Spain
Fernández, M:
Complejo Hosp Univ A Coruna, Med Oncol Dept, La Coruna, Spain
García-Campelo, R:
Complejo Hosp Univ A Coruna, Med Oncol Dept, La Coruna, Spain
Calles, A:
Hosp Univ Gregorio Maranon, Med Oncol Dept, Madrid, Spain
Alvarez, R:
Hosp Univ Gregorio Maranon, Med Oncol Dept, Madrid, Spain
Zapata-García, M:
Hosp Univ Lozano Blesa, Med Oncol Dept, Zaragoza, Spain
Isla, D:
Hosp Univ Lozano Blesa, Med Oncol Dept, Zaragoza, Spain
Callejo, A:
Hosp Univ Vall dHebron, Med Oncol Dept, VHIO, Barcelona, Spain
Iranzo, P:
Hosp Univ Vall dHebron, Med Oncol Dept, VHIO, Barcelona, Spain
Serra-López, J:
Hosp Santa Creu i St Pau, Med Oncol Dept, Barcelona, Spain
Barba, A:
Hosp Santa Creu i St Pau, Med Oncol Dept, Barcelona, Spain
Sullivan, I:
Hosp Santa Creu i St Pau, Med Oncol Dept, Barcelona, Spain
Felip, E:
Hosp Univ Vall dHebron, Med Oncol Dept, VHIO, Barcelona, Spain
Majem, M:
Hosp Santa Creu i St Pau, Med Oncol Dept, Barcelona, Spain
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