Abstract 1113P
Background
Pembrolizumab alone (IO) or with platinum-based chemotherapy (CT-IO) are 1L standard of care for advanced non-small cell lung cancer (NSCLC) patients with PD-L1 ≥ 50%. This retrospective, multicentre study assessed real-world use of both strategies.
Methods
Patients with advanced NSCLC PD-L1 ≥ 50% were included if they received IO or CT-IO from 12-2019 (non-squamous) or 06-2020 (squamous), corresponding to the reimbursement date in France for each subtype. Disease characteristics were collected from 8 Hospitals. Overall survival (OS) and real-word progression-free-survival (rwPFS) were estimated using Kaplan-Meier methodology. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs, and a cox model with inverse propensity treatment weighting was carried out.
Results
Among the 243 patients included, 141 (58%) received IO and 102 (42%) CT-IO. Characteristics were detailed in the table. With a median follow-up of 11.5 months (95% CI, 10.4 – 13.3), median OS was not reached (NR) but no difference was observed between both groups (p=0.51). Early deaths at 3 months were 11% (95% CI 4.6 – 16.9) and 15.2% (95% CI 9.0 – 20.9) in CT-IO and IO groups (p=0.32). Median rwPFS was 11.3 months (95% CI 7.2 – NR) in CT-IO and 10.6 months (95% CI 7.1 – NR) in IO (p=0.76). After adjustment on age, ECOG, histology, brain metastases, liver metastases and tobacco status, no significant difference was found for OS between groups, neither in the multivariate [HR 1.07 (95% CI 0.61 – 1.86), p=0.8] nor in the propensity analysis [HR 0.99 (95% CI 0.60-1.65), p=0.99]. Same conclusion was done for rwPFS in the multivariate [HR 0.98 (95% CI 0.64 – 1.51), p=0.93] and the propensity analysis [HR 1.11 (95% CI 0.74-1.65), p=0.62]. Table: 1113P
| n (%) | IO-mono (n=158) | CT-IO (n=102) | p-value |
| Sex (Men) | 82 (58.2) | 57 (55.9) | 0.793 |
| Age, Median [range] | 68 [47 - 92] | 61 [35 - 81] | <0.001 |
| ECOG 0 – 1 | 106 (75.2) | 84 (82.3) | 0.209 |
| Smoking status Never Current or past | 12 (8.8) 124 (91.2) | 3 (3.0) 96 (97.0) | 0.104 |
| Histology Non-squamous | 115 (81.6) | 97 (95.1) | 0.002 |
| PDL1 90-100 50 - 89 | 59 (41.8) 82 (58.2) | 49 (48.0) 53 (52.0) | 0.362 |
| Symptomatic disease at diagnosis Yes | 102 (72.3) | 90 (88.2) | 0.002 |
| Corticoids at diagnosis ≥ 10 mg/day < 10 mg/day None | 19 (13.8) 2 (1.4) 117 (84.8) | 22 (22.2) 1 (1.0) 76 (76.8) | 0.215 |
| Tumor stage Locally-advanced Metastatic | 26 (18.4) 115 (81.6) | 6 (5.9) 96 (94.1) | 0.004 |
| Only 1 M+ site | 50 (43.5) | 33 (34.3) | 0.006 |
| Brain M+ | 26 (23.4) | 37 (39.4) | 0.003 |
Conclusions
Younger patients, those with a symptomatic disease and brain metastases were more prone to be proposed CT-IO. However, sparing the chemotherapy in 1L does not appear to impact survival outcomes, even regarding early deaths.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Pons-Tostivint Elvire.
Funding
Has not received any funding.
Disclosure
E. Pons-Tostivint: Financial Interests, Institutional, Invited Speaker: AstraZeneca, BMS, Daiichi Sankyo, Sanofi, PDC line, Takeda. All other authors have declared no conflicts of interest.