Real-World Outcomes of Nivolumab, Pembrolizumab, and Atezolizumab Treatment Efficacy in Korean Veterans with Stage IV Non-Small-Cell Lung Cancer

Abstract

In clinical settings, patients receiving immune checkpoint inhibitors (ICIs) have different treatment criteria from those enrolled in clinical trials. There are concerns regarding the efficacy of ICIs in older adults due to the age-associated decline in the immune system, and no study has directly compared the efficacy of different ICIs in a real-world setting. We aimed to analyze ICIs use and treatment outcomes in Korean veterans with stage IV non-small-cell lung cancer (NSCLC). In total, 180 patients diagnosed with stage IV NSCLC between 2016 and 2021 were included in this analysis. Three cohort groups were derived based on ICI type (pembrolizumab, nivolumab, and atezolizumab treatment groups), and their clinical characteristics and survival outcomes were compared. The predictors of survival outcomes in patients with NSCLC were investigated using a Cox regression model. The objective response rate (ORR) was 22.4%, 8.2%, and 4.3% in the pembrolizumab, nivolumab, and atezolizumab groups, respectively, whereas the disease control rate (DCR) was 59.2, 55.7%, and 30.0%, respectively. There was no difference in the overall survival (OS) rate among the groups, and no treatment-specific OS benefit was observed relative to tumor PD-L1 expression, and bone metastasis was a poor prognostic factor for OS. Pembrolizumab and nivolumab were associated with a significant increase in ORR and DCR compared with atezolizumab, and there was no statistically significant difference in survival outcomes among the three ICIs, demonstrating that they may be an appropriate treatment option for older patients.