Abstract 4701
Background
Non-squamous non-small cell lung cancer (NSCLC) accounts for majority of lung cancer, the second most common cancer in US. Combination of checkpoint inhibitors and chemotherapy has become a fundamental paradigm shift in the first-line treatment of advanced lung cancer. We conducted a combined analysis of randomized controlled trials (RCT) to determine the risk of treatment-related adverse events (TRAE) and treatment discontinuation due to TRAE.
Methods
PUBMED, MEDLINE, EMBASE databases and meeting abstracts from inception through March 2019 were queried. RCTs of first-line chemotherapy +/- immunotherapy in patients with advanced non-squamous NSCLC were incorporated. Mantel-Haenszel (MH) method was used to calculate the estimated pooled risk ratio (RR) and risk difference (RD) with 95% confidence interval (CI). Random effects model was applied.
Results
A total of 2785 patients with advanced non-squamous NSCLC from 5 RCTs were included. The study arm used standard chemotherapy regimens in combination with pembrolizumab or atezolizumab while control arm used only standard chemotherapy regimens. The randomization ratio was 2:1 in IMpower-130 and Keynote-189 studies and 1:1 in other studies. The pooled RR of any-grade TRAE was 1.02 (95% CI: 0.99 –1.04, P = 0.20) and RR of high-grade TRAE was significant at 1.20 (95% CI: 1.07 –1.34, P = 0.002). Treatment-related deaths were 58 (3.57%) in study arm vs 31 (2.66%) in control arm. The pooled RR was not statistically significant at 1.26 (95% CI: 0.81 –1.95, P = 0.31) and RD was 0.01 (95% CI: - 0.00 – 0.02, P = 0.08). Treatment discontinuation due to TRAE was noted in 440 (27.14%) vs 235 (20.19%) in control group with RR of 1.35 (95% CI: 1.15 –1.59, P = 0.0003) and RD of 0.07 (95% CI: 0.03 – 0.11, P = 0.001).
Conclusions
Patients on upfront combined chemoimmunotherapy experienced high-grade TRAE, ultimately leading to treatment discontinuation. Yet, there were no significant increase in the risk of treatment related deaths due to TRAE, compared to standard chemotherapy. Pre-emptive measures with proper supportive care may enhance patients’ quality of life and compliance.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Kyaw Zin Thein.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
2182 - Evaluating the prevalence of the expression of PD-L1 in NSCLC specimens with short-duration formalin fixation using IHC 22C3 pharmDx
Presenter: Keiichi Ota
Session: Poster Display session 1
Resources:
Abstract
5255 - [18F]-FDG PET/CT in predicting PD-L1 status in nasopharyngeal carcinoma
Presenter: Liang Zhao
Session: Poster Display session 1
Resources:
Abstract
4910 - Expression of PD-L1 in Chinese Patients with Common Cancers
Presenter: Min Zheng
Session: Poster Display session 1
Resources:
Abstract
4227 - The clearance of EGF by tumor-associated macrophages is suppressed by chemotherapeutic agent cisplatin
Presenter: Irina Larionova
Session: Poster Display session 1
Resources:
Abstract
5222 - VHIO-300 and a thousand one nights, a tale of Precision Medicine
Presenter: Ginevra Caratù
Session: Poster Display session 1
Resources:
Abstract
5668 - Matched Whole-Genome Sequencing and Whole-Exome Sequencing with Circulating Tumor DNA (ctDNA) Analysis are complementary modalities in clinical practice
Presenter: Robin Imperial
Session: Poster Display session 1
Resources:
Abstract
5772 - Exploring the role of genes associated with familial cancer syndromes on the development of multiple primary tumors
Presenter: Atanaska Mitkova
Session: Poster Display session 1
Resources:
Abstract
4784 - Doxorubicin resistance: early and advanced tumors can use two different strategies based on initial and profound abnormalities in microRNA expression signature
Presenter: Volodymyr Halytskiy
Session: Poster Display session 1
Resources:
Abstract
3456 - From tumor transcriptomes to underlying cell type proportions to better predict prognosis and response to treatments
Presenter: Yuna Blum
Session: Poster Display session 1
Resources:
Abstract
4976 - Optimization of automated germline DNA extraction from non-tumoral formalin-fixed paraffin embedded (FFPE) tissues
Presenter: Omar Youssef
Session: Poster Display session 1
Resources:
Abstract