Abstract 90P
Background
Understanding RW outcomes of pts treated with 1L IO ± chemotherapy (CT) may help identify unmet needs and inform future tx strategies. One aim of CORRELATE was to describe post-progression outcomes and second- (2L)/third-line (3L) tx patterns after 1L IO tx in pts with mNSCLC.
Methods
Using the US Flatiron Clinico-Genomic Database, we analysed outcomes and 2L/3L tx patterns in pts with mNSCLC who started US-approved 1L IO tx between 1 Nov 2016 and 31 May 2021, and met select eligibility criteria from 4 pivotal RCTs (KEYNOTE [KN]-024, n=94; KN-189, n=462; KN-407, n=122; IMpower150, n=4; N=682). Time to first subsequent tx (TFST; time from start of 1L tx to start of 2L tx or death) and time to next tx (TTNT; time from start of 2L tx to start of 3L tx or death) in all pts, and within subgroups (IO monotherapy [mono] vs IO + CT, and early vs later progressors) were estimated by Kaplan-Meier analysis.
Results
94 (13.8%) pts received IO mono and 588 (86.2%) IO + CT. 275 (40.3%) received 2L tx; 257 (37.7%) died with no 2L tx; 50 (7.3%) were alive with progressive disease (PD) but no 2L tx; and 100 (14.7%) were alive without PD at data cutoff (31 Dec 2021). 106 (15.5%) received 3L tx. 334 (49.0%) pts had PD or died ≤6 months (mo) after starting 1L IO (early progressors). Median TFST was 7.7 mo and median TTNT was 4.7 mo (Table). Median TFST and TTNT were longer in pts who received 1L IO mono vs IO + CT. Across all subgroups, median TFST was longer than median TTNT. 19.6% (54/275) of pts received IO at 2L and 20.8% (22/106) at 3L; 16.0% (17/106) of pts were rechallenged with IO in 3L after not having IO in 2L. CT ± anti-VEGF was the most common 2L (59.6% [164/275]) and 3L (63.2% [67/106]) regimen. Table: 90P
| All | 1L IO mono | 1L IO + CT | Early progressors* | Later progressors† | |
| 2L tx, % | n=275 | n=41 | n=234 | n=123 | n=152 |
| CT | 34.5 | 41.5 | 33.3 | 35.8 | 33.6 |
| CT + anti-VEGF | 25.1 | 9.8 | 27.8 | 33.3 | 18.4 |
| IO ± CT/other | 19.6 | 22.0 | 19.2 | 13.0 | 25.0 |
| Targeted tx | 9.1 | 17.1 | 7.7 | 7.3 | 10.5 |
| Other | 11.6 | 9.8 | 12.0 | 10.6 | 12.5 |
| TFST (1L–2L), mo | |||||
| Median 95% CI | 7.7 6.8–8.4 | 9.5 5.6–13.1 | 7.5 6.8–8.3 | 5.4 4.9–5.9 | 10.5 9.1–11.9 |
| 3L tx, % | n=106 | n=18 | n=88 | n=49 | n=57 |
| CT | 45.3 | 50.0 | 44.3 | 49.0 | 42.1 |
| CT + anti-VEGF | 17.9 | 11.1 | 19.3 | 22.4 | 14.0 |
| IO ± CT/other | 20.8 | 27.8 | 19.3 | 10.2 | 29.8 |
| Targeted tx | 3.8 | 0 | 4.5 | 4.1 | 3.5 |
| Other | 12.3 | 11.1 | 12.5 | 14.3 | 10.5 |
| TTNT (2L–3L), mo | |||||
| Median 95% CI | 4.7 3.9–5.8 | 6.5 4.6–8.0 | 3.9 3.3–5.3 | 4.9 2.8–6.0 | 4.6 3.4–6.1 |
*PD or died ≤6 mo after starting 1L IO; †PD or died >6 mo after starting 1L IO
Conclusions
Nearly half of the population treated with 1L IO progressed or died within 6 mo from the start of tx, highlighting that improved tx options for pts with mNSCLC remain an important unmet need. For pts able to receive 2L tx, options are limited and results remain suboptimal.
Editorial acknowledgement
Medical writing support for the development of this abstract, under the direction of the authors, was provided by Jean Scott of Ashfield MedComms (Manchester, UK), an Inizio company, and funded by AstraZeneca.
Legal entity responsible for the study
AstraZeneca PLC.
Funding
AstraZeneca.
Disclosure
S.V. Liu: Financial Interests, Personal, Advisory Board: AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Catalyst, Daiichi Sankyo, Eisai, Elevation Oncology, Genentech/Roche, Gilead, Guardant Health, Janssen, Jazz Pharmaceuticals, Merck, Merus, Mirati, Novartis, Pfizer, Regeneron, Sanofi, Takeda, Turning Point Therapeutics; Financial Interests, Institutional, Research Grant: AbbVie, Alkermes, Elevation Oncology, Ellipses, Genentech, Gilead, Merck, Merus, Nuvalent, RAPT, Turning Point Therapeutics; Financial Interests, Personal, Advisory Role: Candel Therapeutics. R.J. Salomonsen: Financial Interests, Personal, Full or part-time Employment: AstraZeneca; Financial Interests, Personal, Stocks/Shares: AstraZeneca; Non-Financial Interests, Institutional, Project Lead: AstraZeneca. P.M. Forde: Financial Interests, Personal, Advisory Board: AstraZeneca, BMS, Genentech, Regeneron; Other, Institutional, Principal Investigator: AstraZeneca, BMS, Regeneron. J. Naidoo: Financial Interests, Personal, Advisory Board: AstraZeneca, BMS, Merck, Roche/Genentech, Amgen, Takeda, Pfizer, Daiichi Sankyo, NGM Pharmaceuticals, Kaleido Biosciences; Financial Interests, Institutional, Research Grant: Merck, AstraZeneca, BMS, Mirati; Financial Interests, Institutional, Principal Investigator: Merck, AstraZeneca, BMS, Mirati. B.C. Cho: Financial Interests, Personal, Invited Speaker: AstraZeneca, Guardant, Roche, Novartis, MSD, The Chinese Thoracic Oncology Society, Pfizer; Financial Interests, Personal, Advisory Board: KANAPH Therapeutic Inc, Bridgebio therapeutics, Cyrus therapeutics, Guardant Health, Oscotec Inc, J INTS Bio, Therapex Co., Ltd, Gliead, Amgen; Financial Interests, Personal, Member of Board of Directors: J INTS BIO; Financial Interests, Personal, Full or part-time Employment: Yonsei University Health System; Financial Interests, Personal, Stocks/Shares: TheraCanVac Inc, Gencurix Inc, Bridgebio therapeutics, KANAPH Therapeutic Inc, Cyrus therapeutics, Interpark Bio Convergence Corp., J INTS BIO; Financial Interests, Personal, Royalties: Champions Oncology, Crown Bioscience, Imagen, PearlRiver Bio GmbH; Financial Interests, Personal, Research Grant: MOGAM Institute, LG Chem, Oscotec, Interpark Bio Convergence Corp, GIInnovation, GI-Cell, Abion, AbbVie, AstraZeneca, Bayer, Blueprint Medicines, Boehringer Ingelheim, Champions Onoclogy, CJ bioscience, CJ Blossom Park, Cyrus, Dizal Pharma, Genexine, Janssen, Lilly, MSD, Novartis, Nuvalent, Oncternal, Ono, Regeneron, Dong-A ST, Bridgebio therapeutics, Yuhan, ImmuneOncia, Illumina, Kanaph therapeutics, Therapex, JINTSbio, Hanmi, CHA Bundang Medical Center, Vertical Bio AG; Financial Interests, Personal, Advisory Role: Abion, BeiGene, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, BMS, CJ, CureLogen, Cyrus therapeutics, Ono, Onegene Biotechnology, Yuhan, Pfizer, Eli Lilly, GI-Cell, Guardant, HK Inno-N, Imnewrun Biosciences Inc., Janssen, Takeda, MSD, Janssen, Medpacto, Blueprint medicines, RandBio, Hanmi; Other, Personal, Other, Founder: DAAN Biotherapeutics. V. Graziano: Financial Interests, Personal, Full or part-time Employment: AstraZeneca. A. Wang: Financial Interests, Personal, Full or part-time Employment: AstraZeneca. M. Cooper: Financial Interests, Personal, Full or part-time Employment: AstraZeneca; Financial Interests, Personal, Stocks/Shares: AstraZeneca. T. Shcherbakova: Financial Interests, Personal, Full or part-time Employment: AstraZeneca. S. Peters: Financial Interests, Institutional, Invited Speaker: AiCME, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, ecancer, Eli Lilly, Foundation Medicine, GSK, Illumina, Imedex, Ipsen, Medscape, Merck Sharp and Dohme, Mirati, Novartis, PER, Peerview, Pfizer, Roche/Genentech, RTP, Sanofi, Takeda; Financial Interests, Institutional, Advisory Board: AbbVie, AiCME, Amgen, Arcus, AstraZeneca, Bayer, BeiGene, BerGenBio, Biocartis, BioInvent, Blueprint Medicines, Boehringer Ingelheim, Bristol Myers Squibb, Clovis, Daiichi Sankyo, Debiopharm, ecancer, Eli Lilly, Elsevier, F-Star, Fishawack, Foundation Medicine, Genzyme, Gilead, GSK, Hutchmed, Illumina, Imedex, IQVIA, Incyte, Ipsen, iTeos, Janssen, Medscape, Medtoday, Merck Sharp and Dohme, Merck Serono, Merrimack, Mirati, Novartis, Novocure, Oncology Education, PharmaMar, Promontory Therapeutics, PER, Peerview, Pfizer, Regeneron, RMEI, Roche/Genentech, RTP, Sanofi, Seattle Genetics, Takeda, Vaccibody; Financial Interests, Institutional, Member of Board of Directors: Galenica; Financial Interests, Institutional, Principal Investigator: Amgen, Arcus, AstraZeneca, BeiGene, Bristol Myers Squibb, GSK, iTeos, Merck Sharp and Dohme, Mirati, PharmaMar, Promontory Therapeutics, Roche/Genentech, Seattle Genetics; Non-Financial Interests, Personal, Member: ESMO, ASCO, AACR, IASLC, SSOM, SAKK, ETOP; Non-Financial Interests, Personal, Advisory Role: Cf. advisory boards; Non-Financial Interests, Personal, Leadership Role: Vice President Swiss Cancer League, past President ESMO, Strategic Advisory board SPCC (Paris Saclay) Chair, ETOP scientific chair.