Renaud Descourt1, Laurent Greillier2, Maurice Perol3, Charles Ricordel4, Jean-Bernard Auliac5, Lionel Falchero6, Radj Gervais7, Rémi Veillon8, Sabine Vieillot9, Florian Guisier10, Marie Marcq11, Grégoire Justeau12, Laurence Bigay-Game13, Marie Bernardi14, Pierre Fournel15, Hélène Doubre16, Julian Pinsolle17, Karim Amrane18, Christos Chouaïd19, Chantal Decroisette20. 1. Oncology Department, Brest University Hospital, Brest, France. 2. Multidisciplinary Oncology and Therapeutic Innovations Department, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Aix Marseille University, Marseille, France. 3. Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France. 4. Pneumology Department, Rennes University Hospital, Rennes, France. 5. Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France. 6. Pneumology Department, Hôpital Nord-Ouest, Villefranche-sur-Saône Hospital, Gleize, France. 7. Oncology Department, Caen François-Baclesse Cancer Center, Caen, France. 8. Pneumology Department, Bordeaux University Hospital, Bordeaux, France. 9. Oncology Department, Perpignan Hospital, Perpignan, France. 10. Pneumology Department, Rouen University Hospital, Rouen, France. 11. Pneumology Department, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France. 12. Oncology Department, Angers University Hospital, Angers, France. 13. Pneumology Department, Toulouse University Hospital, Toulouse, France. 14. Pneumology Department, Aix-en-Provence Hospital, Aix-en-Provence, France. 15. Oncology Department, Institut de Cancérologie de La Loire Lucien Neuwirth, Saint-Priest-en-Jarez, France. 16. Pneumology Department, Hôpital Foch, Suresnes, France. 17. Pneumology Department, Chambéry Métropole Savoie Hospital, Chambéry, France. 18. Oncology Department, Morlaix Hospital, Morlaix, France. 19. Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France. Christos.chouaid@chicreteil.fr. 20. Pneumology Department, Annecy Genevois Hospital, Annecy, France.
Abstract
BACKGROUND: Few real-world data are available in patients with advanced metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy, particularly in those with brain metastases at treatment initiation. METHODS: This was a national, retrospective, multicenter study that consecutively included all patients with PD-L1-positive (tumor proportion score ≥ 50%) advanced NSCLC who initiated first-line treatment with pembrolizumab as a single agent between May 2017 (date of availability of pembrolizumab in this indication in France) to November 22, 2019 (approval of the pembrolizumab-chemotherapy combination). Data were collected from medical records with local response assessment. RESULTS: The cohort included 845 patients and 176 (20.8%) had brain metastases at diagnosis. There were no significant differences in outcomes for patients with and without brain metastases: 9.2 (95% CI 5.6-15) and 8 (95% CI 6.7-9.2, p = 0.3) months for median progression-free survival (PFS) and, 29.5 (95% CI 17.2-NA) and 22 (95% CI 17.8-27.1, p = 0.3) months for median overall survival (OS), respectively. Overall response rates were 47% and 45% in patients with and without cerebral metastases. In multivariate analysis, performance status 2-4 vs. 0-1 and neutrophil-to-lymphocyte ratio ≥ 4 vs. < 4 were the main independent negative factors for OS; brain metastasis was not an independent factor for OS. CONCLUSION: In this large multicenter cohort, nearly 20% of patients initiating pembrolizumab therapy for advanced NSCLC had cerebral metastases. There was no significant difference in response rates, PFS and OS between patients with and without brain metastases.
BACKGROUND: Few real-world data are available in patients with advanced metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy, particularly in those with brain metastases at treatment initiation. METHODS: This was a national, retrospective, multicenter study that consecutively included all patients with PD-L1-positive (tumor proportion score ≥ 50%) advanced NSCLC who initiated first-line treatment with pembrolizumab as a single agent between May 2017 (date of availability of pembrolizumab in this indication in France) to November 22, 2019 (approval of the pembrolizumab-chemotherapy combination). Data were collected from medical records with local response assessment. RESULTS: The cohort included 845 patients and 176 (20.8%) had brain metastases at diagnosis. There were no significant differences in outcomes for patients with and without brain metastases: 9.2 (95% CI 5.6-15) and 8 (95% CI 6.7-9.2, p = 0.3) months for median progression-free survival (PFS) and, 29.5 (95% CI 17.2-NA) and 22 (95% CI 17.8-27.1, p = 0.3) months for median overall survival (OS), respectively. Overall response rates were 47% and 45% in patients with and without cerebral metastases. In multivariate analysis, performance status 2-4 vs. 0-1 and neutrophil-to-lymphocyte ratio ≥ 4 vs. < 4 were the main independent negative factors for OS; brain metastasis was not an independent factor for OS. CONCLUSION: In this large multicenter cohort, nearly 20% of patients initiating pembrolizumab therapy for advanced NSCLC had cerebral metastases. There was no significant difference in response rates, PFS and OS between patients with and without brain metastases.
Authors: Edward B Garon; Naiyer A Rizvi; Rina Hui; Natasha Leighl; Ani S Balmanoukian; Joseph Paul Eder; Amita Patnaik; Charu Aggarwal; Matthew Gubens; Leora Horn; Enric Carcereny; Myung-Ju Ahn; Enriqueta Felip; Jong-Seok Lee; Matthew D Hellmann; Omid Hamid; Jonathan W Goldman; Jean-Charles Soria; Marisa Dolled-Filhart; Ruth Z Rutledge; Jin Zhang; Jared K Lunceford; Reshma Rangwala; Gregory M Lubiniecki; Charlotte Roach; Kenneth Emancipator; Leena Gandhi Journal: N Engl J Med Date: 2015-04-19 Impact factor: 91.245
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Authors: M Chatterjee; D C Turner; E Felip; H Lena; F Cappuzzo; L Horn; E B Garon; R Hui; H-T Arkenau; M A Gubens; M D Hellmann; D Dong; C Li; K Mayawala; T Freshwater; M Ahamadi; J Stone; G M Lubiniecki; J Zhang; E Im; D P De Alwis; A G Kondic; Ø Fløtten Journal: Ann Oncol Date: 2016-04-26 Impact factor: 32.976
Authors: Martin Reck; Delvys Rodríguez-Abreu; Andrew G Robinson; Rina Hui; Tibor Csőszi; Andrea Fülöp; Maya Gottfried; Nir Peled; Ali Tafreshi; Sinead Cuffe; Mary O'Brien; Suman Rao; Katsuyuki Hotta; Ticiana A Leal; Jonathan W Riess; Erin Jensen; Bin Zhao; M Catherine Pietanza; Julie R Brahmer Journal: J Clin Oncol Date: 2021-04-19 Impact factor: 50.717