Abstract 1098P
Background
Pembrolizumab represents a first-line option for advanced NSCLC with high PD-L1 expression (≥50%). However, several factors such as antibiotic-exposure, low body mass index (BMI), bone metastases, or ECOG-PS of 2, may influence outcomes from fist-line pembrolizumab.
Methods
We have evaluated the association between those factors with survival in a cohort of patients with stage IV high PD-L1 expression NSCLC consecutively treated with first-line pembrolizumab.
Results
We included 104 patients between May 2011 and January 2022. The median follow-up was 16.32 months (m) [1.71 – 63.90]. Median age was 68 years (y) (45-86), 75% were male, 26% were current smokers, 23.1% had ECOG-PS2, 40.4% BMI<25, 6.7% antibiotic-exposure, 33.7% received a corticosteroid dose higher than the equivalent to 10mg of prednisone (>10mg PDNe), 57.7% Proton Pump Inhibitors and 83.7% received treatment beyond progression. 7.7% had complete response (CR) as best response, 43.3% had partial response (PR), 15.2% had steable disease (SD), 22.1% had progression disease (PD). Overall Response Rate (ORR): 51%. The median OS and PFS in the overall population were 22.1 m (95% CI, 11.2-33.0) and 11.84 m (95% CI, 4.49-19.19), respectively. The median OS in patients with a ECOG 0-1, CR/PR as best response, receiving treatment beyond progression and without corticosteroid exposure was significantly longer (p<0.0001) (Table). No differences in OS were observed according to the use of Proton Pump Inhibitors, BMI or smoking habit. Table: 1098P
| ECOG-PS | Median OS | p-value | Median PFS | p-value |
| 0 | Not reached (NR) | 26.03 (11.81-40.26) | ||
| 1 | 24.55 (18.34-30.76) | 14.45 (3.48-25.43) | ||
| 2 | 2.13 (1.39-2.87) | <0.0001 | 0.71 (0.42-1.00) | <0.0001 |
| >10mg PDNe | ||||
| Yes | 3.13 (0.0-9.33) | 3.94 (1.26-6.61) | ||
| No | 24.55 (19.77-29.33) | 0.003 | 16.32 (7.71-24.94) | 0.100 |
| Proton Pump Inhibitor exposure | ||||
| Yes | 13.71 (1.75-25.67) | 16.32 (3.95-28.70) | ||
| No | 24.55 (4.87-44.22) | 0.205 | 11.84 (3.71-19.96) | 0.939 |
| Best response | ||||
| CR | NR | NR | ||
| PR | NR | 32.45 (19.82-45.08) | ||
| SD | 11.87 (8.50-15.24) | 4.42 (2.80-6.04) | ||
| PD | 4.77 (2.20-7.35) | <0.0001 | 2.68 (0.0-5.56) | <0.0001 |
| Treatment beyond progression | ||||
| Yes | 31.84 (13.49-50.19) | 14.45 (3.44-25.47) | ||
| No | 10.74 (8.54-12.94) | 0.001 | 3.94 (2.52-5.35) | 0.001 |
Conclusions
ECOG 0-1, not receiving exposure, CR/PR as best response and receiving treatment beyond progression were predictive of better outcome to pembrolizumab in advanced NSCLC patients with high PD-L1 expression.
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.