Retrospective analysis of clinical outcomes of patients with advanced non-small cell lung cancer (NSCLC) exposed to immunotherapy: The experience of the Oncology Center of Hospital Moinhos de Vento.

Abstract

e21720 Background: Lung cancer has the highest mortality rate among malignant neoplasms worldwide. Most cases present an advanced stages. From the last few years, the target drugs and immunotherapy (IO) have emerged as important therapeutic options in this scenario. In Brazil, in 2018, this disease was responsible for 8.7% of cases of malignant neoplasms in men and 6.2% of cases in women. When looking at data from our state, Rio Grande do Sul, the highest rates in the country are noted, with an estimated rate of 40.22 cases for every 100 thousand men and 20.49 cases for every 100 thousand women. Although the available trials point to significant improvements in the clinical outcomes, the real impact of using such treatments on patients in our community practice, real-world scenario, is unknown. Methods: Through the detailed analysis of the institutional electronic medical record, we included patients with metastatic NSCLC, followed up on an outpatient basis at the Oncology Center of Hospital Moinhos de Vento, who had received at least one dose of nivolumab, pembrolizumab or atezolizumab, either as monotherapy or in combination therapy with chemotherapy, in any line of cancer treatment, in the period from January 2015 to June 2019. Primary endpoint was overall survival (OS) and secondary endpoints were time-to-treatment discontinuation (TTD) and treatment-related toxicity (TRT). Results: 41 patients met criteria. The sample consisted of patients with a mean age at diagnosis of 67.7 years, the majority being male (53.7%), stage IVB disease (53.7%), previously smokers (61%) and with non-squamous NSCLC (75.6%). Central nervous system (CNS) metastases were present in 26.8% of patients. About 51.3% (n = 21) received IO as second line or later treatment. At this group, nivolumab was the main IO (81%). The median OS in the first line (1L) of treatment was not reached while in second line and beyond was 10.0 months (3.4 - 16.5), with no statistical difference (p = 0.071). The median TTD was higher in patients whose received IO at 1L (17.0 months vs 7.0 months, p = 0.045). Pneumonitis was the main toxicity being present in 7.1% of patients. Colitis, thyroiditis and hepatitis were seen in one patient each. Conclusions: in general, we were able to observe that in our real-world scenario, IO is well tolerated, regardless of the treatment line. In addition, OS met the findings of the landmark clinical trials.