First-line pembrolizumab in patients with advanced non-small cell lung cancer and high PD-L1 expression

Introduction: Pembrolizumab stands as a first-line option for patients with advanced non-small cell lung cancer (NSCLC) and high programmed death-ligand 1 (PD-L1) expression (PD-L1 ≥50%). Several factors such as antibiotic exposure, low body mass index (BMI), certain metastatic location or poor perf...

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Autores: Piedra, Aida|||0000-0002-4795-1132, Martínez-Recio, Sergio|||0000-0001-8056-7100, Hernández, Ainhoa|||0000-0003-4678-6662, Morán, Teresa, Arriola, Edurne|||0000-0001-8960-7519, Recuero-Borau, Jordi, Cobo, Manuel|||0000-0003-3402-1144, Cordeiro, P., Mosquera, J., Fernández, M., Del Rosario García-Campelo, María|||0000-0003-2113-1504, Calles, A., Álvarez, R., Zapata-García, M., Isla, Dolores|||0000-0002-2483-198X, Callejo, Ana|||0000-0003-2556-8412, Iranzo, Patricia|||0000-0002-9335-2472, Serra, Jorgina|||0000-0002-2363-7149, Barba Joaquin, Andrés|||0000-0003-2500-0253, Sullivan, Ivana|||0000-0002-0434-3436, Felip, Enriqueta|||0000-0002-7620-0098, Majem Tarruella, Margarita|||0000-0002-9919-7485
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:308686
Acceso en línea:https://ddd.uab.cat/record/308686
https://dx.doi.org/urn:doi:10.3389/fonc.2024.1510278
Access Level:acceso abierto
Palabra clave:First-line
High PD-L1 expression
Immune check-point inhibitors
Non-small cell lung cancer
Pembrolizumab
Predictive factors
Descripción
Sumario:Introduction: Pembrolizumab stands as a first-line option for patients with advanced non-small cell lung cancer (NSCLC) and high programmed death-ligand 1 (PD-L1) expression (PD-L1 ≥50%). Several factors such as antibiotic exposure, low body mass index (BMI), certain metastatic location or poor performance status may influence outcomes. Methods: We conducted a multicenter retrospective analysis in a cohort of patients with advanced high PD-L1 expression NSCLC treated with first-line pembrolizumab in clinical practice. We sought to evaluate clinical outcomes according to several factors. Results: Among the 494 included patients, median age was 67.29 years, 77% were male, 54% and 38% were former or current smokers, respectively; 84% had an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 0-1, and 48% had a BMI of <25. 32% of patients had bone metastases, 32% brain metastases and 16% liver metastases. 35% of patients had exposure to antibiotics (AB), 44% to corticosteroids and 62% to proton pump inhibitors (PPi). With a median follow-up of 14.3 months, the median overall survival (OS) and progression-free survival (PFS) were 15.9m (95% CI 13.1 to 18.8) and 9.9m (95% CI 7.7 to 12.1), and the overall response rate (ORR) was 43%. After univariate analysis, median OS in patients with ECOG-PS 0 vs. 1 vs. 2 was 36.7m vs. 14.8m vs. 2.7m (p<0.001). Median OS in patients who received treatment with corticosteroids vs. patients without exposure was 11.4m vs. 22.3m (p<0.001). After multivariate analysis, corticosteroid exposure (HR 1.41) and ECOG-PS (HR 2.40) maintained a prognostic impact. Discussion: First-line pembrolizumab outcomes in advanced high PD-L1 expression NSCLC patients could be negatively influenced by corticosteroid exposure or poor ECOG-PS.

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