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e-Poster Display Session

40P - Efficacy and safety of immune checkpoint inhibitors in previously treated metastatic non-small cell lung cancer


09 Dec 2020


e-Poster Display Session


Tumour Site

Non-Small Cell Lung Cancer


Renato Cunha


Annals of Oncology (2020) 31 (suppl_7): S1428-S1440. 10.1016/annonc/annonc391


R. Cunha1, M. Fernandes2, S. Abreu2, C. Oliveira2, J. Dias2

Author affiliations

  • 1 Hospital Espírito Santo, EPE – Évora, Évora/PT
  • 2 Instituto Portugues de Oncologia do Porto Francisco Gentil, E.P.E, Porto/PT

Abstract 40P


Immune checkpoint inhibitors (ICI) changed the paradigm of cancer treatment. Atezolizumab (anti-PD-L1), nivolumab and pembrolizumab (anti-PD-1) are standard of care in patients with previously treated advanced non-small cell lung cancer (NSCLC). Our aim is to assess efficacy and safety of ICIs in this setting, in a cancer institute, and factors related with survival.


Retrospective observational study of patients with metastatic NSCLC treated in second or further line with ICIs, from 2015 to 2019. Statistical analysis with IBM SPSS software v.25. Overall survival (OS) and progression-free survival (PFS) calculated using Kaplan-Meier curves and factors associated with survival using univariate and multivariate Cox regression analysis. Patient stratification according to age, smoking status, comorbidities, driver mutations, ECOG PS and PD-L1 expression.


96 patients were analyzed, with median follow-up 18 months. Mean age ate the start of ICIs 65 years, 80% male, 79% ECOG 1; PD-L1 was negative in 33% and ≥50% in 23%; 43% treated with nivolumab, 39% pembrolizumab, 18% atezolizumab. 7% presented grade 3-4 adverse events (AEs). Overall response rate (ORR) was 20%, median PFS was 4.5 months and median OS was 12.9 months. PFS was significantly longer in patients without comorbidities (HR 0.56, IC 0.32-0.98; p=0.044) and ECOG 0-1 (HR 0.25, 0.10-0.62; p=0.003). OS was longer in patients with ECOG PS 0-1 (HR 0.20, 0.08-0.53; 0.001). Anti-PD-1 had superior disease control rate (DCR) than anti-PD-L1 (OR 9.93; p=0.001) and PFS was longer with anti-PD-1 (6.4 months) versus anti-PD-L1 (2.3 months; HR 0.27, 0.14-0.53; p<0.001). All subgroups showed benefit from anti-PD-1, except patients under 65 years, with driver mutations and ECOG PS 2. No significant differences were observed in OS or AEs. PD-L1 status did not impact PFS or OS in any of the performed analysis.


This study confirms benefit of ICI in the treatment of NSCLC after first line in our population, with similar results to the literature. We also report a significant relation between absence of comorbidities and ECOG PS with survival. Treatment with anti-PD-1 showed superior DCR and PFS versus anti-PD-L1, but longer follow-up is needed to clarify OS differences.

Legal entity responsible for the study

The authors.


Has not received any funding.


All authors have declared no conflicts of interest.

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