343P - Immunotherapy as first-line treatment in metastatic non-small cell lung cancer: A single center experience

Background

Immunotherapy has revolutionized treatment in metastatic non small cell lung cancer (NSCLC) without driver mutation.In our study we evaluated the efficacy of pembrolizumab in combination with chemotherapy as first line therapy in advanced NSCLC.

Methods

A total of 98 patients received immunotherapy for metastatic NSCLC from January 2016 to January 2022. Out of these 98 patients, 32 patients received pembrolizumab with chemotherapy in biopsy proven metastatic NSCLC. We evaluated disease free survival(DFS) and overall survival(OS) using the kaplan-meier curve. Immune related adverse effects(IRAE) were documented and graded as per the common terminology criteria for adverse events(CTCAE) criteria.

Results

Among the patients evaluated 28 (87%) were males and 4(13%) were females. The median age was 74 years. 27(85%) of the patients were adenocarcinoma and 5(15%) were squamous cell carcinoma. PDL1 was tested using SP263 Ventana and Dako 22C3 platforms. PDL1 was negative(0%) in 14(45%) and positive(>1%) in 18(57%) patients. Out of 32, 22(70%) patients received pembrolizumb in combination with pemetrexed+platin chemotherapy and 10(30%) patients received pembrolizumab with taxane+platin combination. Among the patients who received treatment atleast a partial response was seen in 18(58%), stable disease in 6(19%) and progressive disease in 5(16%) of patients. The median progression free survival was 8 months and overall survival was 16 months. 3 patients have completed> 30 cycles of immunotherapy and having an ongoing response. The most common immune related adverse effect(IRAE) was hypothyroidism seen in 5 patients(Grade1 in 4(12%), Grade 2 in 1(3%) followed by fatigue in 5 patients (Grade 1 in 12%, Grade 2 in 3%). IRAE leading to permanent discontinuation of immunotherapy is seen in only 2 patients(Grade 3 pneumonitis in 1, Grade 3 Colitis in 1).

Conclusions

Our real world experience revealed pembrolizumab in combination with chemotherapy is a safe and effective first line approach, benefit seen in all subgroups irrespective of PDL1 status. Treatment was well tolerated, no significant delays due to IRAEs. Immunotherapy combination with chemotherapy is the ideal approach in metastatic NSCLC without driver mutations.

Clinical trial identification

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.