Background: Programmed cell death 1 (PD-1) inhibitors, such as nivolumab and pembrolizumab, have shown promising efficacy for the treatment of advanced non-small cell lung cancer (NSCLC). However, the efficacy of subsequent chemotherapy when administered during PD-1 inhibitor progression still remains unclear. The objective of this study was to assess the efficacy of subsequent chemotherapy in patients with PD-1 inhibitor-refractory NSCLC. Methods: We retrospectively examined patients with NSCLC who received PD-1 inhibitor at our institute. The endpoints of this study were objective response rates (ORR) and progression-free survival (PFS) for subsequent chemotherapy after PD-1 inhibitor treatment. Results: Among 40 patients who received PD-1 inhibitors, 14 patients underwent subsequent chemotherapy. Although all patients received cytotoxic agents before PD-1 inhibitor administration, most patients did not respond to the cytotoxic agents (ORR 7%). The ORR and median PFS of PD-1 inhibitor was 14% (2 of 14) and 2.8months (95% CI: 1.9-3.8), respectively. The median duration between the last administered PD-1 inhibitor and the initiation of subsequent chemotherapy was 24 days. Docetaxel was most commonly used regimen after PD-1 inhibitors (7 of 14). For subsequent therapy, the ORR and median PFS were 36% (5 of 14) and 4.4months (95%CI: 2.9-6.0), respectively. We observed no association between the response to prior cytotoxic agents or PD-1 inhibitors and the response to subsequent chemotherapy. Conclusion: Subsequent chemotherapy after PD-1 inhibitor treatment exhibited favorable ORR and PFS. PD-1 inhibitor might elevate the sensitivity to subsequent cytotoxic agents.
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