Pembrolizumab for First-Line Treatment of Advanced Non-Small-Cell Lung Cancer: Analysis of Prognostic Factors of Outcomes

Author(s):

Carmelo Tibaldi*, Francesca Mazzoni, Vieri Scotti, Enrico Vasile, Daniele Pozzessere, Irene Stasi, Andrea Camerini, Francesca Federici, Giulia Meoni, Chiara Caparello, Marianna Turrini, Virginia Rossi , Lucia Pia Ciccone, Irene Pecora, Beatrice Fantechi, Lorenzo Antonuzzo, Diana Giannarelli and Editta Baldini   Pages 1278 - 1285 ( 8 )

Abstract:

Background: In advanced non-small-cell lung cancer, without activating mutations and with PD-L1≥50%, Pembrolizumab monotherapy is the therapeutic standard in Europe. <P> Objective: To evaluate retrospectively the safety and efficacy of this drug and to investigate potential prognostic factors in daily clinical practice. <P> Methods: From September 2017 to September 2019, 205 consecutive patients from 14 Italian Medical Oncology Units were enrolled in the study. Gender, Age (> or <70 years), ECOG-PS (0-1 or 2), histology (squamous or nonsquamous), presence of brain, bone and liver metastases at baseline, PD-L1 score (>90% or <90%), smoking status (never or former or current) were applied to the stratified log-rank. Cox’s proportional hazards model was used for multivariate analysis. <P> Results: At a median follow-up of 15.2 months, median progression-free and overall survival (mPFS and mOS) were 9.2 months (95% C.I., 4.8-13.5) and 15.9 months (95% C.I., not yet evaluable), respectively. Patients with Eastern Cooperative Oncology Group performance status (ECOG-PS) 2 had mPFS of 2.8 months (95% C.I., 2.1-3.4) and mOS of 3.9 months (95% C.I., 2.5-5.3). Patients with liver metastases at diagnosis had an mPFS of 3.2 months (95% C.I., 0.6-5.8) and an mOS of 6.0 months (95% C.I., 3.7-8.4). At multivariate analysis for OS gender, ECOG-PS 2, and presence of liver metastases were independent prognostic factors. <P> Conclusion: Patients with ECOG-PS 2 derived little benefit from the use of first-line pembrolizumab. In patients with liver metastases, the association of pembrolizumab with platinum-based chemotherapy could be a better option than pembrolizumab alone.

Keywords:

NSCLC, pembrolizumab, liver metastases, prognostic factors, platinum-based chemotherapy, PD-L1.

Affiliation:

Department of Oncology, S.Luca Hospital, Lucca, epartment of Oncology, Careggi University Hospital, Firenze, Department of Oncology, Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Department of Oncology, Azienda Ospedaliero-Universitaria, Pisa, Division of Medical Oncology, S. Stefano Hospital, Prato, Division of Medical Oncology, Civil Hospital, Livorno, Department of Oncology, Versilia Hospital, Lido di Camaiore, Division of Medical Oncology, Apuane Hospital, Massa, Department of Oncology, S.Giovanni di Dio Hospital, Firenze, Division of Medical Oncology, Piombino, Department of Oncology, S. Maria alla Gruccia Hospital, Montevarchi, Department of Oncology, Careggi University Hospital, Firenze, Department of Oncology, Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Department of Oncology, Azienda Ospedaliero-Universitaria, Pisa, Division of Medical Oncology, S. Stefano Hospital, Prato, Department of Oncology, Careggi University Hospital, Firenze, Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Department of Oncology, S.Luca Hospital, Lucca

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