Abstract 3368
Background
First-line therapy with pembrolizumab is the standard of care in locally advanced and metastatic non-small cell lung cancer (NSCLC) with a PD-L1 expression of ≥ 50%. However, efficacy results in patients with a PS ≥ 2, untreated brain metastases or permanent oral steroids are lacking.
Methods
Patients from six certified lung cancer centers in Berlin, Germany, presenting with stage III (non resectable, not suitable for chemoradiation) and IV NSCLC, with a PD-L1 expression of ≥ 50%, diagnosed or treated between January 1st, 2017 and December 31, 2017 were included in this retrospective study. Progression-free (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Cox regression analyses were used to identify prognostic factors for survival. Values are given as median (range).
Results
During the observation period, 128 patients fulfilled the inclusion criteria. Median age was 68.6 years (39 – 85), 76 patients were male (59.4%). Histology was predominantly non-squamous (68.8%). 31 patients (24.2%) had an initial PS of ≥ 2. Oral steroids for ≥2 weeks (equivalent daily doses of ≥ 10 mg of prednisolone during therapy with pembrolizumab) were prescribed to 34 patients (26.6%). Pembrolizumab was initiated in 24 patients with previously untreated brain metastases (18.8%). Within a follow-up of 13.0 months (95% CI, 10.5 – 15.4), a median of 9 cycles (1 – 38) were administered corresponding to a duration of treatment of 6.9 months (95% CI, 4.6 – 9.2). Therapy was still ongoing in 30 patients (23.4%). PFS was 9.4 months (95% CI, 4.8 – 14.1) with a duration of response of 11.9 months (95%CI, 8.4 – 15.4). OS reached 18.9 months (95% CI, NE – NE). A PS ≥ 2 was associated with a reduced OS (HR 0.43, 95% CI, 0.25 – 0.75, p = 0.003), no effects were noted for brain metastases and steroids.
Conclusions
Our data from real life practice in an all comer population demonstrate the efficacy of pembrolizumab in NSCLC with a PD-L1 expression of ≥ 50%. Despite a reduced survival in PS ≥ 2, the reached OS of 8.0 months is superior to historic cohorts with cytotoxic chemotherapy. Furthermore, OS was unchanged in case of untreated brain metastases or permanent steroids.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
920 - Efficacy of intravenous (IV) NEPA, a fixed NK1/5-HT3 receptor antagonist (RA) combination, for prevention of CINV following cisplatin- and anthracycline cyclophosphamide (AC)-based chemotherapy (CT)
Presenter: Lee Schwartzberg
Session: Poster Display session 1
Resources:
Abstract
5146 - Efficacy of olanzapine combination in prevention of nausea & vomiting in highly emetogenic chemotherapy
Presenter: Smitha Saldanha
Session: Poster Display session 1
Resources:
Abstract
1947 - Patient-reported outcome data during real-world use of NEPA for prevention of chemotherapy-induced nausea and vomiting in high-risk platin-receiving patients - A prospective multicenter trial
Presenter: Meinolf Karthaus
Session: Poster Display session 1
Resources:
Abstract
6163 - A study evaluating steroid induced metabolic syndrome after antiemetic dexamethasone therapy in patients received high emetic risk chemotherapy
Presenter: Hee Jun Kim
Session: Poster Display session 1
Resources:
Abstract
2154 - High incidence of nausea during initial and repeated courses if intravenous chemotherapy in patients receiving guideline consistent antiemetic prophylaxis - a prospective, observational, real world study.
Presenter: Teresa Smit
Session: Poster Display session 1
Resources:
Abstract
1637 - "Randomised controlled trial of Scalp Cooling (SC) for the prevention of Chemotherapy Induced Alopecia (CIA)”
Presenter: Jyoti Bajpai
Session: Poster Display session 1
Resources:
Abstract
5351 - Performance of the ‘4S rule’ to predict short-term outcomes in cancer outpatients with unsuspected pulmonary embolism.
Presenter: David Pesántez Coronel
Session: Poster Display session 1
Resources:
Abstract
1189 - Prevalence of venous thromboembolism based on intensive screening for patients with advanced solid tumor in prospective observational study
Presenter: Shota Omori
Session: Poster Display session 1
Resources:
Abstract
4340 - Short-term outcomes of cancer patients with pulmonary embolism according to the setting (hospital-acquired vs. outpatient) at diagnosis.
Presenter: Diego Muñoz Guglielmetti
Session: Poster Display session 1
Resources:
Abstract
4658 - Patient-reported outcomes associated with switching to rivaroxaban for the treatment of venous thromboembolism (VTE) in patients with active cancer
Presenter: Alexander Cohen
Session: Poster Display session 1
Resources:
Abstract