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Personal and clinical characteristics associated with immunotherapy effectiveness in stage IV non-small cell lung cancer

BACKGROUND: Immunotherapy response rates in metastatic non-small cell lung cancer (NSCLC) are low and survival varies significantly. Factors like age, sex, race, and histology may modulate immunotherapy response. Existing analyses are limited to clinical trials, with limited generalizability, and me...

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Autores principales: Patel, Krishna H., Alpert, Naomi, Tuminello, Stephanie, Taioli, Emanuela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10326785/
https://www.ncbi.nlm.nih.gov/pubmed/37425397
http://dx.doi.org/10.21037/tlcr-22-682
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author Patel, Krishna H.
Alpert, Naomi
Tuminello, Stephanie
Taioli, Emanuela
author_facet Patel, Krishna H.
Alpert, Naomi
Tuminello, Stephanie
Taioli, Emanuela
author_sort Patel, Krishna H.
collection PubMed
description BACKGROUND: Immunotherapy response rates in metastatic non-small cell lung cancer (NSCLC) are low and survival varies significantly. Factors like age, sex, race, and histology may modulate immunotherapy response. Existing analyses are limited to clinical trials, with limited generalizability, and meta-analyses where adjustment for potential confounders cannot be performed. Here, we conduct a cohort study with patient-level analysis to explore how personal and clinical characteristics moderate chemoimmunotherapy effectiveness in metastatic NSCLC. METHODS: Stage IV NSCLC patients diagnosed in 2015 were drawn from Surveillance Epidemiology, and End Results-Medicare linked data. Receipt of chemoimmunotherapy and overall survival (OS) were the primary predictor and outcome of interest respectively. Multivariable Cox-proportional hazards regression and propensity-score matching were performed to evaluate the effectiveness of immunotherapy addition to chemotherapy. RESULTS: From a total of 1,471 patients, 349 (24%) received chemoimmunotherapy and 1,122 (76%) received chemotherapy alone. Survival was significantly better among those treated with chemoimmunotherapy compared to those receiving chemotherapy alone [adjusted hazard ratio (HR(adj)) =0.72, 95% confidence interval (CI): 0.63–0.83]. Males saw significantly better OS from chemoimmunotherapy (HR(adj) =0.62, 95% CI: 0.51–0.75) than females (HR(adj) =0.81, 95% CI: 0.65–1.01, P(interaction)=0.0557). After propensity-score matching, the effect of chemoimmunotherapy was borderline significant according to sex (P(interaction) =0.0414), but not age or histology. CONCLUSIONS: Males may benefit more from chemoimmunotherapy, but there is limited evidence suggesting age, histology, race, and comorbidities contribute to differences in effectiveness. Future research should elucidate who responds best to chemoimmunotherapy, and further analyses of characteristics like race can inform how to tailor different treatment regimens to distinct patient subpopulations.
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spelling pubmed-103267852023-07-08 Personal and clinical characteristics associated with immunotherapy effectiveness in stage IV non-small cell lung cancer Patel, Krishna H. Alpert, Naomi Tuminello, Stephanie Taioli, Emanuela Transl Lung Cancer Res Original Article BACKGROUND: Immunotherapy response rates in metastatic non-small cell lung cancer (NSCLC) are low and survival varies significantly. Factors like age, sex, race, and histology may modulate immunotherapy response. Existing analyses are limited to clinical trials, with limited generalizability, and meta-analyses where adjustment for potential confounders cannot be performed. Here, we conduct a cohort study with patient-level analysis to explore how personal and clinical characteristics moderate chemoimmunotherapy effectiveness in metastatic NSCLC. METHODS: Stage IV NSCLC patients diagnosed in 2015 were drawn from Surveillance Epidemiology, and End Results-Medicare linked data. Receipt of chemoimmunotherapy and overall survival (OS) were the primary predictor and outcome of interest respectively. Multivariable Cox-proportional hazards regression and propensity-score matching were performed to evaluate the effectiveness of immunotherapy addition to chemotherapy. RESULTS: From a total of 1,471 patients, 349 (24%) received chemoimmunotherapy and 1,122 (76%) received chemotherapy alone. Survival was significantly better among those treated with chemoimmunotherapy compared to those receiving chemotherapy alone [adjusted hazard ratio (HR(adj)) =0.72, 95% confidence interval (CI): 0.63–0.83]. Males saw significantly better OS from chemoimmunotherapy (HR(adj) =0.62, 95% CI: 0.51–0.75) than females (HR(adj) =0.81, 95% CI: 0.65–1.01, P(interaction)=0.0557). After propensity-score matching, the effect of chemoimmunotherapy was borderline significant according to sex (P(interaction) =0.0414), but not age or histology. CONCLUSIONS: Males may benefit more from chemoimmunotherapy, but there is limited evidence suggesting age, histology, race, and comorbidities contribute to differences in effectiveness. Future research should elucidate who responds best to chemoimmunotherapy, and further analyses of characteristics like race can inform how to tailor different treatment regimens to distinct patient subpopulations. AME Publishing Company 2023-06-13 2023-06-30 /pmc/articles/PMC10326785/ /pubmed/37425397 http://dx.doi.org/10.21037/tlcr-22-682 Text en 2023 Translational Lung Cancer Research. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Patel, Krishna H.
Alpert, Naomi
Tuminello, Stephanie
Taioli, Emanuela
Personal and clinical characteristics associated with immunotherapy effectiveness in stage IV non-small cell lung cancer
title Personal and clinical characteristics associated with immunotherapy effectiveness in stage IV non-small cell lung cancer
title_full Personal and clinical characteristics associated with immunotherapy effectiveness in stage IV non-small cell lung cancer
title_fullStr Personal and clinical characteristics associated with immunotherapy effectiveness in stage IV non-small cell lung cancer
title_full_unstemmed Personal and clinical characteristics associated with immunotherapy effectiveness in stage IV non-small cell lung cancer
title_short Personal and clinical characteristics associated with immunotherapy effectiveness in stage IV non-small cell lung cancer
title_sort personal and clinical characteristics associated with immunotherapy effectiveness in stage iv non-small cell lung cancer
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10326785/
https://www.ncbi.nlm.nih.gov/pubmed/37425397
http://dx.doi.org/10.21037/tlcr-22-682
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