A Comparative Study of Immunotherapy as Second-Line Treatment and beyond in Patients with Advanced Non-Small-Cell Lung Carcinoma

Abstract

Background: Immunotherapy has demonstrated an improved overall survival (OS) and progression-free survival (PFS) as second-line treatment and subsequent lines compared with chemotherapy. Materials and methods: This was a retrospective review among eight medical centers comprising 100 patients with a confirmed diagnosis of non-small-cell lung carcinoma, in their second-line treatment or beyond with immune checkpoints inhibitors treatment. The current study aimed to analyze effectiveness of immunotherapy in second-line treatment or further in the Mexican population, using PFS rate, OS rate and the best objective response to treatment by RECIST 1.1 as a surrogate of effectiveness. Results: In total, 100 patients met the criteria for enrollment in the current study. From the total study population, 49 patients (49.0%) were male and 51 (51.0%) were female, with an average age of 60 years and stage IV as the most prevalent clinical stage at the beginning of the study. A total of 61 patients (61.0%) had partial response; 11 (11.0%) stable disease; 2 (2.0%), complete response, 4 (4.0%), progression; and 22 (22.0%) were nonevaluable. We found a median PFS of 4 months (95% CI: 3.2–4.7 months) and an OS of 9 months (95% CI: 7.2–10.7 months). Conclusion: The response to immunotherapy is similar, with an improvement in OS and PFS, independent of which drug is used. Patients using nivolumab had a better survival, although that was not statistically significant.

Differentially Expressed Genes Involved in Primary Resistance to Immunotherapy in Patients with Advanced-Stage Pulmonary Cancer

“…In fact, in the present study, the three patients with complete response after nivolumab treatment showed ≤ 40% PD-L1 expression (0%, 30%, and 40%). In the second line, benefits have also been observed with immunotherapy combined with chemotherapy when PD-L1 expression is ≥ 1% [28][29][30]. Unfortunately, there is a subgroup of patients who do not benefit from immunotherapy despite having positive PD-L1 expression, while other patients who do not display PD-L1 expression respond adequately to immunotherapy; this is the case for one of the patients in our series, who achieved a complete response after treatment with nivolumab (patient ID4; Table 1) and whose immunohistochemical study revealed an absence of PD-L1 expression.…”

Búsqueda de biomarcadores pronósticos y terapéuticos en el carcinoma pulmonar de células escamosas. Correlación clínico-patológica

“…No obstante, en segunda línea también se han observado beneficios con la inmunoterapia combinada con la quimioterapia cuando la expresión de PD-L1 es ≥1%. (216)(217)(218)(219). Desafortunadamente, existe un subgrupo de pacientes que no se beneficia de la inmunoterapia a pesar de tener una expresión positiva de PD-L1 y, por el contrario, otros pacientes que muestran expresión de PD-L1 responden adecuadamente a la inmunoterapia, como ocurrió en uno de los pacientes de nuestra serie.…”