Abstract 89P
Background
Despite treatment (tx) advances for a/mNSCLC, outcomes remain poor. This study aimed to identify characteristics associated with clinical outcomes in pts with a/mNSCLC treated with pembrolizumab-based MT.
Methods
This US-based retrospective study used the nationwide Flatiron Health electronic health record–derived deidentified database. Eligible pts (≥18 years with a/mNSCLC) initiated pembrolizumab first-line MT (1LM) after platinum-based induction chemo+pembrolizumab (01Jun2017–30Sep2021). Predictors of rw time to next tx/death (rwTTNTD) and rw overall survival (rwOS) from start of 1LM were identified.
Results
Overall (N=1944; 77.1% nonsquamous [NSQ]; median follow-up: 12.2 mo), 1302 pts advanced to next tx/died. Univariable median rwTTNTD and rwOS were 9.2 and 18.7 mo, respectively. rwTTNTD did not differ significantly for squamous (SQ) vs NSQ (HR, 1.1; 95% CI, 1.0–1.3; P=0.2). rwOS was significantly shorter for SQ vs NSQ (HR, 1.3; 95% CI, 1.1–1.5; P=0.01). For NSQ, rwOS did not differ significantly with induction pemetrexed vs without (20.0 vs 17.7 months, HR, 0.9; 95% CI, 0.6–1.3; P=0.5). Multivariable rwTTNTD was significantly shorter in pts who lost weight from diagnosis to start of 1LM (≥10%, adjusted HR [adjHR], 1.7; 95% CI, 1.4–2.0; P<0.0001; 5%–<10%, adjHR, 1.3; 95% CI, 1.2–1.5; P<0.0001; reference: none/<5%/missing) with similar rwOS results (adjHR, 2.1; 95% CI, 1.7–2.5; P<0.0001; adjHR, 1.5; 95% CI, 1.3–1.8; P<0.0001). Other predictors of shorter rwTTNTD and rwOS (P<0.05) were lower PD-L1 percentage, male sex, high ECOG PS, high monocyte levels (vs normal), high/>median platelet-to-lymphocyte ratio (vs low/≤median), and low creatinine levels (vs normal/unknown). Similar predictors of rwTTNTD and rwOS were observed for SQ and NSQ, with fewer significant associations for SQ, potentially because of lower statistical power.
Conclusions
Poor clinical outcomes persist despite immunotherapy-based MT, revealing an unmet need. Novel regimens may benefit pts who are male, display malnutrition, have poor functional status, and exhibit imbalances between systemic inflammation/immunity.
Editorial acknowledgement
Writing and editorial support, funded by GSK (Waltham, MA, USA) and coordinated by Chun Zhou, PhD, CMPP, and Prudence L. Roaf, MPH, of GSK, was provided by Jessica M. Weems, PhD, and Jennifer Robertson, PhD, of Ashfield MedComms, an Inizio company.
Legal entity responsible for the study
GSK.
Funding
GSK.
Disclosure
V. Velcheti: Non-Financial Interests, Institutional, Advisory Board, including consultant: Amgen, AstraZeneca, Bristol Myers Squibb, Janssen, Merck. X. Sun: Financial Interests, Personal, Full or part-time Employment: GSK. J. Nguyen: Financial Interests, Personal, Full or part-time Employment, Was an employee when the analysis was conducted: GSK; Financial Interests, Personal, Full or part-time Employment: Bayer. N. Zimmerman: Financial Interests, Personal, Full or part-time Employment: GSK. K. Phiri, M.V. Shah, C. Solem, X. Zhu, A. Liao: Financial Interests, Personal, Full or part-time Employment: GSK. K. Bell: Financial Interests, Personal, Stocks/Shares: GSK; Financial Interests, Personal, Full or part-time Employment: GSK. M. Altan: Financial Interests, Institutional, Other, Grant support: Adaptimmune, Eli Lilly, Genentech, Gilead, Jounce Therapeutics, Merck, Novartis; Financial Interests, Institutional, Other, Grant support and Consulting fees: Bristol-Myers Squibb, GSK, Shattuck Labs; Financial Interests, Institutional, Other, Grant support and honoraria fees: Nektar Therapeutics; Financial Interests, Personal, Other, Consulting and honoraria fees: AstraZeneca; Financial Interests, Personal, Other, Honoraria fees: Society for Immunotherapy of Cancer (SITC); Non-Financial Interests, Institutional, Advisory Board: Hengenix, Nanobiotix–MDA alliance.