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Real-World Outcomes and Prognostic Factors Among Patients with Advanced Non-Small Cell Lung Cancer and High PD-L1 Expression Treated with Immune Checkpoint Inhibitors as First-Line Therapy

BACKGROUND: Immune checkpoint inhibitors (ICIs) are standard-of-care for patients with advanced non-small cell lung cancer (aNSCLC) and programmed cell death-ligand 1 (PD-L1) expression ≥50%. METHODS: A retrospective cohort study was conducted using the US de-identified electronic health record-deri...

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Autores principales: Ge, Wenzhen, Wu, Ning, Jalbert, Jessica J, Quek, Ruben G W, Liu, Jinjie, Rietschel, Petra, Pouliot, Jean-Francois, Harnett, James, Hsu, Melinda Laine, Feliciano, Josephine L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675996/
https://www.ncbi.nlm.nih.gov/pubmed/36415537
http://dx.doi.org/10.2147/CMAR.S376510
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author Ge, Wenzhen
Wu, Ning
Jalbert, Jessica J
Quek, Ruben G W
Liu, Jinjie
Rietschel, Petra
Pouliot, Jean-Francois
Harnett, James
Hsu, Melinda Laine
Feliciano, Josephine L
author_facet Ge, Wenzhen
Wu, Ning
Jalbert, Jessica J
Quek, Ruben G W
Liu, Jinjie
Rietschel, Petra
Pouliot, Jean-Francois
Harnett, James
Hsu, Melinda Laine
Feliciano, Josephine L
author_sort Ge, Wenzhen
collection PubMed
description BACKGROUND: Immune checkpoint inhibitors (ICIs) are standard-of-care for patients with advanced non-small cell lung cancer (aNSCLC) and programmed cell death-ligand 1 (PD-L1) expression ≥50%. METHODS: A retrospective cohort study was conducted using the US de-identified electronic health record-derived Flatiron Health aNSCLC database (January 1, 2018, to July 31, 2021) among patients with PD-L1 ≥50% initiating first-line ICIs with or without chemotherapy. A clinical trial-like sub-cohort was also identified with Eastern Cooperative Oncology Group performance status 0–1, adequate organ function, and no brain metastases or other primary cancers. Kaplan–Meier methods were used to estimate time to treatment discontinuation, time to next treatment, progression-free survival and overall survival (OS) by ICI regimen (ICI+chemotherapy, ICI monotherapy) and PD-L1 expression (50–69%, 70–89%, 90–100%). Cox proportional hazard models were used to examine associations between ICI regimen, PD-L1 level, and OS, adjusting for baseline demographic and clinical variables. RESULTS: A total of 2631 patients with aNSCLC initiating ICI+chemotherapy (n = 992) or ICI monotherapy (n = 1639) were included; median (Q1, Q3) age was 71 (63–78) years and 51.6% were male. The trial-like sub-cohort (n = 1029) generally had better outcomes vs. the overall cohort. Patients receiving ICI+chemotherapy generally had longer median OS vs. ICI monotherapy. Multivariable analyses showed no association between ICI regimen and OS among patients with PD-L1 70–89% (hazard ratio [HR]: 0.90, 95% confidence interval [CI]: 0.73–1.09) or 90–100% (HR: 0.91, 95% CI: 0.77–1.08), but patients with PD-L1 50–69% receiving ICI+chemotherapy had longer OS (HR: 0.80, 95% CI: 0.64–0.99). CONCLUSION: Outcomes in real-world clinical trial-like patients with aNSCLC approached those reported in pivotal ICI trials in high PD-L1 expressers. ICI monotherapy offers a potential alternative in patients with PD-L1 ≥70% while avoiding potential chemotherapy toxicity exposure; the benefits are less clear in patients with PD-L1 50–69%. Future studies should confirm these findings.
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spelling pubmed-96759962022-11-21 Real-World Outcomes and Prognostic Factors Among Patients with Advanced Non-Small Cell Lung Cancer and High PD-L1 Expression Treated with Immune Checkpoint Inhibitors as First-Line Therapy Ge, Wenzhen Wu, Ning Jalbert, Jessica J Quek, Ruben G W Liu, Jinjie Rietschel, Petra Pouliot, Jean-Francois Harnett, James Hsu, Melinda Laine Feliciano, Josephine L Cancer Manag Res Original Research BACKGROUND: Immune checkpoint inhibitors (ICIs) are standard-of-care for patients with advanced non-small cell lung cancer (aNSCLC) and programmed cell death-ligand 1 (PD-L1) expression ≥50%. METHODS: A retrospective cohort study was conducted using the US de-identified electronic health record-derived Flatiron Health aNSCLC database (January 1, 2018, to July 31, 2021) among patients with PD-L1 ≥50% initiating first-line ICIs with or without chemotherapy. A clinical trial-like sub-cohort was also identified with Eastern Cooperative Oncology Group performance status 0–1, adequate organ function, and no brain metastases or other primary cancers. Kaplan–Meier methods were used to estimate time to treatment discontinuation, time to next treatment, progression-free survival and overall survival (OS) by ICI regimen (ICI+chemotherapy, ICI monotherapy) and PD-L1 expression (50–69%, 70–89%, 90–100%). Cox proportional hazard models were used to examine associations between ICI regimen, PD-L1 level, and OS, adjusting for baseline demographic and clinical variables. RESULTS: A total of 2631 patients with aNSCLC initiating ICI+chemotherapy (n = 992) or ICI monotherapy (n = 1639) were included; median (Q1, Q3) age was 71 (63–78) years and 51.6% were male. The trial-like sub-cohort (n = 1029) generally had better outcomes vs. the overall cohort. Patients receiving ICI+chemotherapy generally had longer median OS vs. ICI monotherapy. Multivariable analyses showed no association between ICI regimen and OS among patients with PD-L1 70–89% (hazard ratio [HR]: 0.90, 95% confidence interval [CI]: 0.73–1.09) or 90–100% (HR: 0.91, 95% CI: 0.77–1.08), but patients with PD-L1 50–69% receiving ICI+chemotherapy had longer OS (HR: 0.80, 95% CI: 0.64–0.99). CONCLUSION: Outcomes in real-world clinical trial-like patients with aNSCLC approached those reported in pivotal ICI trials in high PD-L1 expressers. ICI monotherapy offers a potential alternative in patients with PD-L1 ≥70% while avoiding potential chemotherapy toxicity exposure; the benefits are less clear in patients with PD-L1 50–69%. Future studies should confirm these findings. Dove 2022-11-16 /pmc/articles/PMC9675996/ /pubmed/36415537 http://dx.doi.org/10.2147/CMAR.S376510 Text en © 2022 Ge et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Ge, Wenzhen
Wu, Ning
Jalbert, Jessica J
Quek, Ruben G W
Liu, Jinjie
Rietschel, Petra
Pouliot, Jean-Francois
Harnett, James
Hsu, Melinda Laine
Feliciano, Josephine L
Real-World Outcomes and Prognostic Factors Among Patients with Advanced Non-Small Cell Lung Cancer and High PD-L1 Expression Treated with Immune Checkpoint Inhibitors as First-Line Therapy
title Real-World Outcomes and Prognostic Factors Among Patients with Advanced Non-Small Cell Lung Cancer and High PD-L1 Expression Treated with Immune Checkpoint Inhibitors as First-Line Therapy
title_full Real-World Outcomes and Prognostic Factors Among Patients with Advanced Non-Small Cell Lung Cancer and High PD-L1 Expression Treated with Immune Checkpoint Inhibitors as First-Line Therapy
title_fullStr Real-World Outcomes and Prognostic Factors Among Patients with Advanced Non-Small Cell Lung Cancer and High PD-L1 Expression Treated with Immune Checkpoint Inhibitors as First-Line Therapy
title_full_unstemmed Real-World Outcomes and Prognostic Factors Among Patients with Advanced Non-Small Cell Lung Cancer and High PD-L1 Expression Treated with Immune Checkpoint Inhibitors as First-Line Therapy
title_short Real-World Outcomes and Prognostic Factors Among Patients with Advanced Non-Small Cell Lung Cancer and High PD-L1 Expression Treated with Immune Checkpoint Inhibitors as First-Line Therapy
title_sort real-world outcomes and prognostic factors among patients with advanced non-small cell lung cancer and high pd-l1 expression treated with immune checkpoint inhibitors as first-line therapy
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675996/
https://www.ncbi.nlm.nih.gov/pubmed/36415537
http://dx.doi.org/10.2147/CMAR.S376510
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