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Naratornsirakul D, Chewaskulyong B, Kongkarnka S, Oranratnachai S. Comparison of treatment outcome between first-line combination immunotherapy (anti-PD-L1 or anti-PD1) with or without chemotherapy and chemotherapy alone in advanced non-small cell lung cancer patients in tertiary care hospital. Cancer Med 2024; 13:e70007. [PMID: 39030820 PMCID: PMC11257996 DOI: 10.1002/cam4.70007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Despite promising outcomes of first-line immunotherapy with or without chemotherapy in advanced non-small cell lung cancer (NSCLC), limited accessibility due to reimbursement was remain the problem in low to middle income countries. This study aimed to evaluate real-world effectiveness of immunotherapy in patients with advanced NSCLC in Northern Thailand. METHOD A retrospective, single-centered cohort, was conducted. Patients with advanced NSCLC who underwent PD-L1 testing (excluding EGFR and ALK mutations) and were treated with immunotherapy or without chemotherapy or chemotherapy alone were included. The primary end point was progression-free survival (PFS). The secondary endpoints were overall survival (OS), objective response rate (ORR), and adverse events. RESULTS A total of 123 patients, of which 21 patients received immunotherapy-based regimen and 102 patients received chemotherapy alone. The median PFS was 11.9 months in immunotherapy-based group compared to 5.93 months in the chemotherapy group, with a. hazard ratio (HR) of 0.4 (95% confidence interval [CI], 0.23 to 0.68; p = 0.001). Similarly, the median OS was 26.68 months in the immunotherapy-based group and 11.21 months in the chemotherapy group, with HR of 0.42 (95% CI 0.22-0.8; p = 0.009). ORRs were significantly higher in the immunotherapy-based group, with 65% of patients showing a response compared to 32% in the chemotherapy group (p = 0.006). CONCLUSION The result of this real-world study in patients with advanced stage NSCLC indicate that first-line immunotherapy-based regimen was associated with significantly greater PFS, OS, and ORR with a safety profile consistent with pivotal studies.
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Affiliation(s)
- Danainut Naratornsirakul
- Division of Medical Oncology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Busyamas Chewaskulyong
- Division of Medical Oncology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Sarawut Kongkarnka
- Department of Pathology, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
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Papazyan T, Denis MG, Sagan C, Raimbourg J, Herbreteau G, Pons-Tostivint E. Impact of PD-L1 Expression on the Overall Survival of Caucasian Patients with Advanced EGFR-Mutant NSCLC Treated with Frontline Osimertinib. Target Oncol 2024; 19:611-621. [PMID: 38825654 DOI: 10.1007/s11523-024-01072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The treatment of advanced non-small cell lung cancer (NSCLC) harboring an oncogenic epidermal growth factor receptor mutation (EGFRm) is currently based on osimertinib, a third-generation tyrosine kinase inhibitor (TKI). High Programmed death ligand 1 (PD-L1) expression ≥ 50% demonstrated to be a negative prognostic factor, mostly among Asian populations treated with 1st/2nd generation TKI. OBJECTIVE We investigated the impact of PD-L1 expression on the progression free survival (PFS) and overall survival (OS) within a cohort of patients receiving osimertinib as first-line treatment. METHODS Our bi-centre French retrospective study included all newly diagnosed patients with an advanced EGFRm (common and uncommon) NSCLC, between May 2018 and November 2022, treated with osimertinib. The primary endpoint was OS according to tumor proportion score PD-L1 expression (low/intermediate < 50% vs high ≥ 50%). Survival analyses were performed using Kaplan-Meier method and Cox model for adjusted multivariate analysis. RESULTS Of 96 patients, median age was 71 (IQR 62-76), 70 were women (72.9%), 81 had a performance status (PS) 0-1 (84.3%). Median follow-up was 22.6 months (95% CI 20.5-24.7). Twenty patients (20.8%) had high PD-L1 expression ≥ 50%. No significant differences in baseline characteristics were observed based on PD-L1 status. Patients with PD-L1 ≥ 50% had significant shorter PFS and OS than those with PD-L1 < 50%, respectively 9.3 vs 17.5 months (p = 0.044 months) and 14.3 vs 26.0 months (p = 0.025). Multivariable adjustment for baseline characteristics found that PS ≥ 2 (HR 2.79, 95% CI 1.12-6.93, p = 0.027), PD-L1 ≥ 50% (HR 2.61, 95% CI 1.31 to 5.22, p = 0.007) and uncommon EGFR mutation (HR 4.59, 95% CI 1.95-10.80, p = <0.001) were associated with a shorter OS. Brain metastases at diagnosis and age ≥ 65 were not, respectively HR 1.66 (95% CI 0.90-3.06, p = 0.11) and HR 0.95 (95% CI 0.50-1.80, p=0.9). CONCLUSIONS Our study found that PD-L1 expression ≥ 50% was associated with a shorter OS in EGFRm NSCLC patients treated with first line osimertinib. Further research is warranted to understand the underlying molecular and cellular mechanisms of this correlation.
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Affiliation(s)
- Thomas Papazyan
- Medical oncology, Centre Hospitalier Universitaire Nantes, Nantes University, Boulevard Professeur Jacques Monod, 44800, Saint Herblain, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Marc G Denis
- Department of Biochemistry, Centre Hospitalier Universitaire Nantes, Nantes University, 44000, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
| | - Christine Sagan
- Pathology Department, Centre Hospitalier Universitaire Nantes, Nantes University, 44000, Nantes, France
| | - Judith Raimbourg
- Department of Medical Oncology, Comprehensive Cancer Center, Institut de Cancérologie de L'Ouest, Saint-Herblain, France
| | - Guillaume Herbreteau
- Department of Biochemistry, Centre Hospitalier Universitaire Nantes, Nantes University, 44000, Nantes, France
| | - Elvire Pons-Tostivint
- Medical oncology, Centre Hospitalier Universitaire Nantes, Nantes University, Boulevard Professeur Jacques Monod, 44800, Saint Herblain, France.
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France.
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3
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Knetki-Wróblewska M, Dziadziuszko R, Jankowski T, Krawczyk P, Bryl M, Stencel K, Wrona A, Bandura A, Smok-Kalwat J, Rok-Knapińska J, Szydziak-Zwierzyńska K, Rogoziewicz K, Czyżewicz G, Wójtowicz M, Wojtukiewicz M, Kalinka E, Wysocki PJ, Łobacz M, Milanowski J, Pawlik H, Kowalski DM, Krzakowski M. Pembrolizumab-combination therapy for NSCLC- effectiveness and predictive factors in real-world practice. Front Oncol 2024; 14:1341084. [PMID: 38322415 PMCID: PMC10844541 DOI: 10.3389/fonc.2024.1341084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction Pembrolizumab combined with chemotherapy has become the standard of care for patients with non-small-cell lung cancer (NSCLC) and the expression of programmed death ligand 1 (PD-L1) in <50% of tumour cells (TC). Methods We evaluated the efficacy of the treatment in real-world practice, paying attention to the predictive factors, with a special focus on low level of PD-L1 expression. This study is a multicenter retrospective analysis of patients with stage IV NSCLC. Results A group of 339 consecutive patients was analysed, among them 51% patients with low PD-L1 expression. In the overall population, the ORR was 40.6%, median PFS and OS were 13 months (95% CI 11.4-15) and 16.8 months (95% CI 13.3-20.3), respectively. In multivariate analysis for the entire study population, performance status - ECOG 1 vs. 0 (HR 2.2, 95%CI 1.1-4.6; p=0.02), neutrophil to lymphocyte ratio (NLR)>3 (HR 2.3, 95%CI 1.3-4.2; p=0.04), presence of liver (HR 2.0, 95%CI 1-3.7; p=0. 03) and bone metastases (HR 1.3, 95%CI 1-3; p=0.04), weight loss (HR 1.8, 95%CI 1.1-2.8; p=0.01) and sum of measurable lesions diameters >110 mm (HR 1.7, 95%CI 1-2.9, p=0.049) had a negative impact on OS. Conclusions In the real world, patients can clinically benefit from immunochemotherapy, regardless of the expression of PD-L1 and the histological type. Other clinicopathological factors such as performance status, extent, and location of secondary lesions have prognostic significance.
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Affiliation(s)
- Magdalena Knetki-Wróblewska
- Department of Lung Cancer and Chest Tumours, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Rafał Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Jankowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Paweł Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Maciej Bryl
- Department of Clinical Oncology with the Subdepartment of Diurnal Chemotherapy E. J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - Katarzyna Stencel
- Department of Clinical Oncology with the Subdepartment of Diurnal Chemotherapy E. J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - Anna Wrona
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Artur Bandura
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | | | | | | | - Krzysztof Rogoziewicz
- Department of Clinical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, Wroclaw, Poland
| | - Grzegorz Czyżewicz
- Department of Clinical Oncology, The John Paul II Specialist Hospital, Cracow, Poland
| | - Monika Wójtowicz
- Department of Clinical Oncology, Medical University of Bialystok, Bialystok, Poland
| | - Marek Wojtukiewicz
- Department of Clinical Oncology, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Kalinka
- Department of Clinical Oncology, Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
| | - Piotr J. Wysocki
- Department of Clinical Oncology, Jagiellonian University-Collegium Medicum Hospital, Cracow, Poland
| | - Mateusz Łobacz
- Department of Clinical Oncology, Jagiellonian University-Collegium Medicum Hospital, Cracow, Poland
| | - Janusz Milanowski
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Hubert Pawlik
- Computational Oncology Department, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Dariusz M. Kowalski
- Department of Lung Cancer and Chest Tumours, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Chest Tumours, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Russell PA, Farrall AL, Prabhakaran S, Asadi K, Barrett W, Cooper C, Cooper W, Cotton S, Duhig E, Egan M, Fox S, Godbolt D, Gupta S, Hassan A, Leslie C, Leong T, Moffat D, Qiu MR, Sivasubramaniam V, Skerman J, Snell C, Walsh M, Whale K, Klebe S. Real-world prevalence of PD-L1 expression in non-small cell lung cancer: an Australia-wide multi-centre retrospective observational study. Pathology 2023; 55:922-928. [PMID: 37833206 DOI: 10.1016/j.pathol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/30/2023] [Accepted: 08/17/2023] [Indexed: 10/15/2023]
Abstract
An investigator-initiated, Australia-wide multi-centre retrospective observational study was undertaken to investigate the real-world prevalence of programmed death ligand-1 (PD-L1) expression in non-small cell lung carcinoma (NSCLC). Multiple centres around Australia performing PD-L1 immunohistochemistry (IHC) were invited to participate. Histologically confirmed NSCLC of any stage with a PD-L1 IHC test performed for persons aged ≥18 years between 1 January 2018 and 1 January 2020, and eligible for review, were identified at each centre, followed by data extraction and de-identification, after which data were submitted to a central site for collation and analysis. In total data from 6690 eligible PD-L1 IHC tests from histologically (75%) or cytologically (24%) confirmed NSCLC of any stage were reviewed from persons with a median age of 70 years, 43% of which were female. The majority (81%) of tests were performed using the PD-L1 IHC SP263 antibody with the Ventana BenchMark Ultra platform and 19% were performed using Dako PD-L1 IHC 22C3 pharmDx assay. Reported PD-L1 tumour proportion score (TPS) was ≥50% for 30% of all tests, with 62% and 38% scoring PD-L1 ≥1% and <1%, respectively. Relative prevalence of clinicopathological features with PD-L1 scores dichotomised to <50% and ≥50%, or to <1% and ≥1%, were examined. Females scored ≥1% slightly more often than males (64% vs 61%, respectively, p=0.013). However, there was no difference between sexes or age groups (<70 or ≥70 years) where PD-L1 scored ≥50%. Specimens from patients with higher stage (III/IV) scored ≥1% or ≥50% marginally more often compared to specimens from patients with lower stage (I/II) (p≤0.002). Proportions of primary and metastatic specimens did not differ where PD-L1 TPS was ≥1%, however more metastatic samples scored TPS ≥50% than primary samples (metastatic vs primary; 34% vs 27%, p<0.001). Cytology and biopsy specimens were equally reported, at 63% of specimens, to score TPS ≥1%, whereas cytology samples scored TPS ≥50% slightly more often than biopsy samples (34% vs 30%, respectively, p=0.004). Resection specimens (16% of samples tested) were reported to score TPS ≥50% or ≥1% less often than either biopsy or cytology samples (p<0.001). There was no difference in the proportion of tests with TPS ≥1% between PD-L1 IHC assays used, however the proportion of tests scored at TPS ≥50% was marginally higher for 22C3 compared to SP263 (34% vs 29%, respectively, p<0.001). These real-world Australian data are comparable to some previously published global real-world data, with some differences noted.
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Affiliation(s)
- Prudence A Russell
- LifeStrands Genomics and, TissuPath Pathology, Mount Waverley, Vic, Australia
| | - Alexandra L Farrall
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Sarita Prabhakaran
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - Wade Barrett
- Anatomical Pathology, St Vincent's Hospital Sydney, NSW, Australia
| | - Caroline Cooper
- Pathology Queensland, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Wendy Cooper
- Anatomical Pathology, Royal Prince Alfred Hospital, NSW, Australia
| | - Samuel Cotton
- Anatomical Pathology, Royal Hobart Hospital, Tas, Australia
| | - Edwina Duhig
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Matthew Egan
- Anatomical Pathology, St Vincent's Hospital Melbourne, Vic, Australia
| | - Stephen Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - David Godbolt
- Pathology Queensland, Prince Charles Hospital, Brisbane, Qld, Australia
| | - Shilpa Gupta
- Pathology Queensland, Prince Charles Hospital, Brisbane, Qld, Australia
| | - Aniza Hassan
- SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Connull Leslie
- Anatomical Pathology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Trishe Leong
- Anatomical Pathology, St Vincent's Hospital Melbourne, Vic, Australia
| | - David Moffat
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Min Ru Qiu
- Anatomical Pathology, St Vincent's Hospital Sydney, NSW, Australia
| | - Vanathi Sivasubramaniam
- Anatomical Pathology, St Vincent's Hospital Sydney, NSW, Australia; Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Joanna Skerman
- Pathology Queensland, Prince Charles Hospital, Brisbane, Qld, Australia
| | - Cameron Snell
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - Michael Walsh
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Karen Whale
- Anatomical Pathology, Royal Hobart Hospital, Tas, Australia
| | - Sonja Klebe
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia.
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5
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Zhu Z, Jiang W, Zhou D, Zhu W, Chen C. A clinical spectrum of resectable lung adenocarcinoma with micropapillary component (MPC) concurrently presenting as mixed ground-glass opacity nodules. Cancer Biomark 2023:CBM230104. [PMID: 38143336 DOI: 10.3233/cbm-230104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND In clinical practice, preoperative identification of mixed ground-glass opacity (mGGO) nodules with micropapillary component (MPC) to facilitate the implementation of individualized therapeutic strategies and avoid unnecessary surgery is increasingly importantOBJECTIVE: This study aimed to build a predictive model based on clinical and radiological variables for the early identification of MPC in lung adenocarcinoma presenting as mGGO nodules. METHODS The enrolled 741 lung adenocarcinoma patients were randomly divided into a training cohort and a validation cohort (3:1 ratio). The pathological specimens and preoperative images of malignant mGGO nodules from the study subjects were retrospectively reviewed. Furthermore, in the training cohort, selected clinical and radiological variables were utilized to construct a predictive model for MPC prediction. RESULTS The MPC was found in 228 (43.3%) patients in the training cohort and 72 (41.1%) patients in the validation cohort. Based on the predictive nomogram, the air bronchogram was defined as the most dominant independent risk factor for MPC of mGGO nodules, followed by the maximum computed tomography (CT) value (> 200), adjacent to pleura, gender (male), and vacuolar sign. The nomogram demonstrated good discriminative ability with a C-index of 0.783 (95%[CI] 0.744-0.822) in the training cohort and a C-index of 0.799 (95%[CI] 0.732-0.866) in the validation cohort Additionally, by using the bootstrapping method, this predictive model calculated a corrected AUC of 0.774 (95% CI: 0.770-0.779) in the training cohort. CONCLUSIONS This study proposed a predictive model for preoperative identification of MPC in known lung adenocarcinomas presenting as mGGO nodules to facilitate individualized therapy. This nomogram model needs to be further externally validated by subsequent multicenter studies.
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Affiliation(s)
- Ziwen Zhu
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Weizhen Jiang
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Danhong Zhou
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Weidong Zhu
- Pathology Department, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Cheng Chen
- Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Rodriguez-Lara V, Soca-Chafre G, Avila-Costa MR, Whaley JJJV, Rodriguez-Cid JR, Ordoñez-Librado JL, Rodriguez-Maldonado E, Heredia-Jara NA. Role of sex and sex hormones in PD-L1 expression in NSCLC: clinical and therapeutic implications. Front Oncol 2023; 13:1210297. [PMID: 37941543 PMCID: PMC10628781 DOI: 10.3389/fonc.2023.1210297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023] Open
Abstract
Currently, immunotherapy based on PD-1/PD-L1 pathway blockade has improved survival of non-small cell lung cancer (NSCLC) patients. However, differential responses have been observed by sex, where men appear to respond better than women. Additionally, adverse effects of immunotherapy are mainly observed in women. Studies in some types of hormone-dependent cancer have revealed a role of sex hormones in anti-tumor response, tumor microenvironment and immune evasion. Estrogens mainly promote immune tolerance regulating T-cell function and modifying tumor microenvironment, while androgens attenuate anti-tumor immune responses. The precise mechanism by which sex and sex hormones may modulate immune response to tumor, modify PD-L1 expression in cancer cells and promote immune escape in NSCLC is still unclear, but current data show how sexual differences affect immune therapy response and prognosis. This review provides update information regarding anti-PD-1/PD-L immunotherapeutic efficacy in NSCLC by sex, analyzing potential roles for sex hormones on PD-L1 expression, and discussing a plausible of sex and sex hormones as predictive response factors to immunotherapy.
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Affiliation(s)
- Vianey Rodriguez-Lara
- Department of Cell and Tissue Biology, Faculty of Medicine, UNAM, Mexico City, Mexico
| | - Giovanny Soca-Chafre
- Oncological Diseases Research Unit (UIEO), Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Maria Rosa Avila-Costa
- Neuromorphology Laboratory, Facultad de Estudios Superiores Iztacala, UNAM, Mexico City, Mexico
| | | | | | | | - Emma Rodriguez-Maldonado
- Traslational Medicine Laboratory, Research Unit UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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7
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Tanimura K, Takeda T, Kataoka N, Yoshimura A, Nakanishi K, Yamanaka Y, Yoshioka H, Honda R, Uryu K, Fukui M, Chihara Y, Takei S, Kawachi H, Yamada T, Tamiya N, Okura N, Yamada T, Murai J, Shiotsu S, Kurata T, Takayama K. First-Line Chemoimmunotherapy versus Sequential Platinum-Based Chemotherapy Followed by Immunotherapy in Patients with Non-Small Cell Lung Cancer with ≤49% Programmed Death-Ligand 1 Expression: A Real-World Multicenter Retrospective Study. Cancers (Basel) 2023; 15:4988. [PMID: 37894357 PMCID: PMC10605814 DOI: 10.3390/cancers15204988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The long overall survival (OS) observed among patients with non-small cell lung cancer (NSCLC) with high programmed death-ligand 1 (PD-L1) expression in chemoimmunotherapy (CIT) groups in previous phase III trials suggests the limited efficacy of CIT among the subgroup with ≤49% PD-L1 expression on tumor cells. Hence, sequential treatment with first-line platinum-based chemotherapy followed by second-line immune checkpoint inhibitor treatment (SEQ) is an option. This study examined whether first-line CIT would provide better outcomes than SEQ in patients with advanced NSCLC with ≤49% PD-L1 expression. METHODS This retrospective study evaluated patients with untreated NSCLC who received first-line CIT or SEQ at nine hospitals in Japan. OS, progression-free survival (PFS), PFS-2 (the time from first-line treatment to progression to second-line treatment or death), and other related outcomes were evaluated between the CIT and SEQ groups. RESULTS Among the 305 enrolled patients, 234 eligible patients were analyzed: 165 in the CIT group and 69 in the SEQ group. The COX proportional hazards model suggested a significant interaction between PD-L1 expression and OS (p = 0.006). OS in the CIT group was significantly longer than that in the SEQ group in the 1-49% PD-L1 expression subgroup but not in the <1% PD-L1 expression subgroup. Among the subgroup with 1-49% PD-L1 expression, the CIT group exhibited longer median PFS than the SEQ group (CIT: 9.3 months (95% CI: 6.7-14.8) vs. SEQ:5.5 months (95% CI: 4.5-6.1); p < 0.001), while the median PFS in the CIT group was not statistically longer than the median PFS-2 in the SEQ group (p = 0.586). There was no significant difference between the median PFS in the CIT and SEQ groups among the <1% PD-L1 expression subgroup (p = 0.883); the median PFS-2 in the SEQ group was significantly longer than the median PFS in the CIT group (10.5 months (95% CI: 5.9-15.3) vs. 6.4 months (95% CI: 4.9-7.5); p = 0.024). CONCLUSIONS CIT is recommended for patients with NSCLC with 1-49% PD-L1 expression because it significantly improved OS and PFS compared to SEQ. CIT had limited benefits in patients with <1% PD-L1 expression, and the median PFS-2 in the SEQ group was significantly longer than the median PFS in the CIT group. These findings will help physicians select the most suitable treatment option for patients with NSCLC, considering PD-L1 expressions.
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Affiliation(s)
- Keiko Tanimura
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan; (K.T.); (N.K.); (A.Y.)
| | - Takayuki Takeda
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan; (K.T.); (N.K.); (A.Y.)
| | - Nobutaka Kataoka
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan; (K.T.); (N.K.); (A.Y.)
| | - Akihiro Yoshimura
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto 602-8026, Japan; (K.T.); (N.K.); (A.Y.)
| | - Kentaro Nakanishi
- Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata 573-1191, Japan; (K.N.); (Y.Y.); (H.Y.); (T.K.)
| | - Yuta Yamanaka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata 573-1191, Japan; (K.N.); (Y.Y.); (H.Y.); (T.K.)
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata 573-1191, Japan; (K.N.); (Y.Y.); (H.Y.); (T.K.)
| | - Ryoichi Honda
- Department of Respiratory Medicine, Asahi General Hospital, Asahi 289-2511, Japan;
| | - Kiyoaki Uryu
- Department of Respiratory Medicine, Yao Tokushukai General Hospital, Yao 581-0011, Japan;
| | - Mototaka Fukui
- Department of Respiratory Medicine, Uji-Tokushukai Medical Center, Uji 611-0041, Japan; (M.F.); (Y.C.)
| | - Yusuke Chihara
- Department of Respiratory Medicine, Uji-Tokushukai Medical Center, Uji 611-0041, Japan; (M.F.); (Y.C.)
| | - Shota Takei
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.T.); (H.K.); (T.Y.); (K.T.)
| | - Hayato Kawachi
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.T.); (H.K.); (T.Y.); (K.T.)
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.T.); (H.K.); (T.Y.); (K.T.)
| | - Nobuyo Tamiya
- Department of Respiratory Medicine, Rakuwakai Otowa Hospital, Kyoto 607-8062, Japan;
| | - Naoko Okura
- Department of Respiratory Medicine, Matsushita Memorial Hospital, Moriguchi 570-8540, Japan; (N.O.); (T.Y.)
| | - Takahiro Yamada
- Department of Respiratory Medicine, Matsushita Memorial Hospital, Moriguchi 570-8540, Japan; (N.O.); (T.Y.)
| | - Junji Murai
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto 605-0981, Japan; (J.M.); (S.S.)
| | - Shinsuke Shiotsu
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto 605-0981, Japan; (J.M.); (S.S.)
| | - Takayasu Kurata
- Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata 573-1191, Japan; (K.N.); (Y.Y.); (H.Y.); (T.K.)
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (S.T.); (H.K.); (T.Y.); (K.T.)
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