Giulio Metro1, Alfredo Addeo2, Diego Signorelli3, Alessio Gili4, Panagiota Economopoulou5, Fausto Roila1, Giuseppe Banna6, Alessandro De Toma3, Juliana Rey Cobo2, Andrea Camerini7, Athina Christopoulou8, Giuseppe Lo Russo3, Marco Banini1, Domenico Galetta9, Beatriz Jimenez10, Ana Collazo-Lorduy10, Antonio Calles11, Panagiotis Baxevanos12, Helena Linardou13, Paris Kosmidis14, Marina C Garassino3, Giannis Mountzios15. 1. Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy. 2. Department of Oncology, Geneva University Hospital, Geneva, Switzerland. 3. Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale Tumori di Milano, Milano, Italy. 4. Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy. 5. Oncology Department, Attikon University Hospital, Athens, Greece. 6. Medical Oncology, Ospedale Cannizzaro, Catania, Italy. 7. U.O.C. Oncologia, Ospedale Versilia, Lido di Camaiore (LU), Italy. 8. Medical Oncology, Agios Andreas General Hospital of Patras, Patras, Greece. 9. Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy. 10. Medical Oncology, Hospital Universitario HM Sanchinarro, Madrid, Spain. 11. Division of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 12. Second Department of Medical Oncology, Saint Savvas Anti-Cancer Hospital, Athens, Greece. 13. First Department of Medical Oncology, Metropolitan Hospital, Athens, Greece. 14. Second Department of Medical Oncology, Hygeia Hospital, Athens, Greece. 15. Second Department of Medical Oncology, Henry Dunant Hospital Center, Athens, Greece.
Abstract
BACKGROUND: In this real-world multicenter study we addressed the activity of post-progression anticancer treatments after first-line pembrolizumab in advanced non-small cell lung cancer (NSCLC) patients with PD-L1 ≥50%. METHODS: Clinico-pathological data of PD-L1 ≥50% advanced NSCLCs who failed first-line pembrolizumab were collected in 14 Oncologic Centers from different European countries. Types of subsequent anticancer treatment and outcomes on salvage chemotherapy or pembrolizumab beyond progression with or without the addition of local ablative therapies were reported. RESULTS: Out of 173 patients, 100 had progressed on pembrolizumab, of which 60 patients (60%) met eligibility criteria and were treated with either salvage chemotherapy (42/60, 70%) or pembrolizumab beyond progression (18/60, 30%). Overall, median age was 66 years, 63.3% were male, 60.0% had a performance status of 0-1, 88.3% were smokers and 61.7% had adenocarcinoma histology. In patients evaluable for response, objective response rate to salvage chemotherapy was 41.9%, with no significant difference according to the type of regimen (42.9% for platinum-based and 40.0% for single-agent chemotherapy). Median progression-free survival (PFS) to salvage chemotherapy was 4.5 months. Among patients treated with pembrolizumab beyond progression, 13 out of 18 patients (72.2%) had progressive disease in ≤2 organ sites, of whom 9 (69.2%) were managed with the addition of local ablative therapies consisting of radiation at progressive lesion(s). No significant difference was noted in terms of post-progression survival between the salvage chemotherapy and the pembrolizumab beyond progression groups of patients (6.9 versus 8.1 months, respectively, P=0.08). CONCLUSIONS: In PD-L1 ≥50% advanced NSCLCs who progress on first-line pembrolizumab, salvage chemotherapy is associated with a remarkable anticancer activity, while select patients may benefit from continuation of pembrolizumab beyond progression, with the possible addition of local ablative radiotherapy in oligoprogressive cases. 2019 Journal of Thoracic Disease. All rights reserved.
BACKGROUND: In this real-world multicenter study we addressed the activity of post-progression anticancer treatments after first-line pembrolizumab in advanced non-small cell lung cancer (NSCLC) patients with PD-L1 ≥50%. METHODS: Clinico-pathological data of PD-L1 ≥50% advanced NSCLCs who failed first-line pembrolizumab were collected in 14 Oncologic Centers from different European countries. Types of subsequent anticancer treatment and outcomes on salvage chemotherapy or pembrolizumab beyond progression with or without the addition of local ablative therapies were reported. RESULTS: Out of 173 patients, 100 had progressed on pembrolizumab, of which 60 patients (60%) met eligibility criteria and were treated with either salvage chemotherapy (42/60, 70%) or pembrolizumab beyond progression (18/60, 30%). Overall, median age was 66 years, 63.3% were male, 60.0% had a performance status of 0-1, 88.3% were smokers and 61.7% had adenocarcinoma histology. In patients evaluable for response, objective response rate to salvage chemotherapy was 41.9%, with no significant difference according to the type of regimen (42.9% for platinum-based and 40.0% for single-agent chemotherapy). Median progression-free survival (PFS) to salvage chemotherapy was 4.5 months. Among patients treated with pembrolizumab beyond progression, 13 out of 18 patients (72.2%) had progressive disease in ≤2 organ sites, of whom 9 (69.2%) were managed with the addition of local ablative therapies consisting of radiation at progressive lesion(s). No significant difference was noted in terms of post-progression survival between the salvage chemotherapy and the pembrolizumab beyond progression groups of patients (6.9 versus 8.1 months, respectively, P=0.08). CONCLUSIONS: In PD-L1 ≥50% advanced NSCLCs who progress on first-line pembrolizumab, salvage chemotherapy is associated with a remarkable anticancer activity, while select patients may benefit from continuation of pembrolizumab beyond progression, with the possible addition of local ablative radiotherapy in oligoprogressive cases. 2019 Journal of Thoracic Disease. All rights reserved.
Entities:
Keywords:
Local ablative therapy; PD-L1 ≥50%; non-small cell lung cancer (NSCLC); pembrolizumab beyond progression; salvage chemotherapy
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