Real-world Maintenance Therapy and Survival Outcomes For Pembrolizumab Plus Pemetrexed and Platinum for Non-Small-Cell Lung Cancer in USA

Aggarwal, Himani; Bayo, K.; Han, Yimei; Muehlenbein, Catherine; Zhu, Yajun Emily; Kim, Jong Seok

doi:10.2217/imt-2022-0166

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…9% of all patients)in this group, median OS was 21 months, compared to 9 months in patients who discontinued treatment earlier than the end of the induction phase due to side effects, disease progression, or death. Aggarval et al identified performance status (ECOG ≥2), age >75 years and stage IV disease as the most significant factors indicating a risk of premature completion of treatment (23). In our analysis, age was not significant, while performance status, higher disease burden, and disease progression had a negative impact on OS.…”

Section: Discussioncontrasting

confidence: 46%

“…Aggarval et al. identified performance status (ECOG ≥2), age >75 years and stage IV disease as the most significant factors indicating a risk of premature completion of treatment ( 23 ). In our analysis, age was not significant, while performance status, higher disease burden, and disease progression had a negative impact on OS.…”

Section: Discussionmentioning

confidence: 99%

“…The differences between subgroups were significant with respect to PFS (p=0.0016) (22). Aggarval et al presented an analysis of a large cohort of patients diagnosed with non-small-cell lung cancer (23). A total of, 2488 patients were analysed, of which 833 had low PD-L1 expression.…”

Section: Discussionmentioning

confidence: 99%

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Pembrolizumab-combination therapy for NSCLC- effectiveness and predictive factors in real-world practice

Knetki-Wróblewska,

Dziadziuszko,

Jankowski

et al. 2024

Front. Oncol.

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IntroductionPembrolizumab combined with chemotherapy has become the standard of care for patients with non-small-cell lung cancer (NSCLC) and the expression of programmed death ligand 1 (PD-L1) in <50% of tumour cells (TC).MethodsWe evaluated the efficacy of the treatment in real-world practice, paying attention to the predictive factors, with a special focus on low level of PD-L1 expression. This study is a multicenter retrospective analysis of patients with stage IV NSCLC.ResultsA group of 339 consecutive patients was analysed, among them 51% patients with low PD-L1 expression. In the overall population, the ORR was 40.6%, median PFS and OS were 13 months (95% CI 11.4-15) and 16.8 months (95% CI 13.3-20.3), respectively. In multivariate analysis for the entire study population, performance status – ECOG 1 vs. 0 (HR 2.2, 95%CI 1.1-4.6; p=0.02), neutrophil to lymphocyte ratio (NLR)>3 (HR 2.3, 95%CI 1.3-4.2; p=0.04), presence of liver (HR 2.0, 95%CI 1-3.7; p=0. 03) and bone metastases (HR 1.3, 95%CI 1-3; p=0.04), weight loss (HR 1.8, 95%CI 1.1-2.8; p=0.01) and sum of measurable lesions diameters >110 mm (HR 1.7, 95%CI 1-2.9, p=0.049) had a negative impact on OS.ConclusionsIn the real world, patients can clinically benefit from immunochemotherapy, regardless of the expression of PD-L1 and the histological type. Other clinicopathological factors such as performance status, extent, and location of secondary lesions have prognostic significance.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

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Pembrolizumab-combination therapy for NSCLC- effectiveness and predictive factors in real-world practice

Knetki-Wróblewska,

Dziadziuszko,

Jankowski

et al. 2024

Front. Oncol.

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“…[29] A real-world study reported an mOS of 21.00 months with pembrolizumab plus pemetrexed maintenance therapy. [30] The Impower150 trial showed that adding atezolizumab to bevacizumab plus carboplatin plus paclitaxel followed by maintenance with atezolizumab, bevacizumab, or both led to an mPFS of 8.3 months. [31] The CameL-sq trial showed carboplatin plus paclitaxel with camrelizumab/placebo followed by camrelizumab/placebo maintenance led to an mPFS of 8.5 versus 4.9 months.…”

Section: Discussionmentioning

confidence: 99%

Maintenance therapy with anlotinib after induction therapy with platinum-based chemotherapy for advanced non-small-cell lung cancer: A pooled analysis of 2 single-arm trials

Liu,

Miao,

Chen

et al. 2024

Medicine

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Background: Maintenance therapy could significantly improve the prognosis of patients with advanced non-small cell lung cancer (NSCLC) receiving chemotherapy. Anlotinib is effective, tolerable, and convenient in administration as a third-line treatment for NSCLC. This study aimed to evaluate the efficacy and safety of maintenance therapy with anlotinib after platinum-based induction chemotherapy for patients with advanced NSCLC. Methods: This pooled analysis of 2 multicenter, open-label, single-arm, phase 2 clinical trials (ALTER-L014 and ALTER-L011) enrolled patients with locally advanced or metastatic NSCLC and without known sensitive mutations in China between September 2018 and January 2021. The primary outcome was progression-free survival. The secondary outcomes were objective response rate, disease control rate, overall survival, and safety. Results: The data of 23 patients were pooled, with 15 from ALTER-L014 and 8 from ALTER-L011. At the cutoff date of June 13, 2021, the median progression-free survival since the start of maintenance therapy was 5.95 (95% confidence interval, 4.30–8.80) months. Nineteen patients had stable disease, 1 had a partial response and 3 had progressive disease. The objective response rate was 4.35%, while disease control rate was 86.96%. The median overall survival of the patients since the start of maintenance therapy was 18.60 (95% confidence interval, 6.87–22.80) months. The incidence of adverse events of grade ≥ 3 was 21.7%. Conclusion: Anlotinib might offer a new option for maintenance treatment in patients with locally advanced or metastatic NSCLC without known sensitive mutations after standard first-line platinum-based chemotherapy.

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“…The landmark clinical trials of chemoIO were designed with four to six cycles of induction chemoIO followed by platinum-free maintenance therapy for up to 2 years ( 1, 13–15 ). However, the real-world adoption of maintenance therapy is variable in terms of timing, duration, and dosing ( 16 ). Moreover, the duration of response during maintenance therapy is unpredictable with a subset of patients achieving durable response and others developing rapid disease progression ( 1, 17–20 ).…”

Section: Introductionmentioning

confidence: 99%

Circulating Tumor DNA Monitoring on Chemo-immunotherapy for Risk Stratification in Advanced Non–Small Cell Lung Cancer

Pellini,

Madison,

Childress

et al. 2023

Clinical Cancer Research

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Purpose: Chemoimmunotherapy (chemoIO) is a prevalent first-line treatment for advanced driver-negative non–small cell lung cancer (NSCLC), with maintenance therapy given after induction. However, there is significant clinical variability in the duration, dosing, and timing of maintenance therapy after induction chemoIO. We used circulating tumor DNA (ctDNA) monitoring to inform outcomes in patients with advanced NSCLC receiving chemoIO. Experimental Design: This retrospective study included 221 patients from a phase III trial of atezolizumab+carboplatin+nab-paclitaxel versus carboplatin+nab-paclitaxel in squamous NSCLC (IMpower131). ctDNA monitoring used the FoundationOne Tracker involving comprehensive genomic profiling of pretreatment tumor tissue, variant selection using an algorithm to exclude nontumor variants, and multiplex PCR of up to 16 variants to detect and quantify ctDNA. Results: ctDNA was detected (ctDNA+) in 96% of pretreatment samples (median, 93 mean tumor molecules/mL), and similar ctDNA dynamics were noted across treatment arms during chemoIO. ctDNA decrease from baseline to C4D1 was associated with improved outcomes across multiple cutoffs for patients treated with chemoIO. When including patients with missing plasma or ctDNA- at baseline, patients with ctDNA- at C4D1 (clearance), had more favorable progression-free survival (median 8.8 vs. 3.5 months; HR, 0.32;0.20–0.52) and OS (median not reached vs. 8.9 months; HR, 0.22; 0.12–0.39) from C4D1 than ctDNA+ patients. Conclusions: ctDNA monitoring during induction chemoIO can inform treatment outcomes in patients with advanced NSCLC. Importantly, monitoring remains feasible and informative for patients missing baseline ctDNA. ctDNA testing during induction chemoIO identifies patients at higher risk for disease progression and may inform patient selection for novel personalized maintenance or second-line treatment strategies.

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Real-world Maintenance Therapy and Survival Outcomes For Pembrolizumab Plus Pemetrexed and Platinum for Non-Small-Cell Lung Cancer in USA

Cited by 7 publications

References 24 publications

Pembrolizumab-combination therapy for NSCLC- effectiveness and predictive factors in real-world practice

Pembrolizumab-combination therapy for NSCLC- effectiveness and predictive factors in real-world practice

Maintenance therapy with anlotinib after induction therapy with platinum-based chemotherapy for advanced non-small-cell lung cancer: A pooled analysis of 2 single-arm trials

Circulating Tumor DNA Monitoring on Chemo-immunotherapy for Risk Stratification in Advanced Non–Small Cell Lung Cancer

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