BC Cancer-Victoria, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada.
University of British Columbia, Victoria, BC, Canada.
J Cancer Res Clin Oncol. 2023 Jul;149(7):2951-2961. doi: 10.1007/s00432-022-04181-0. Epub 2022 Jul 14.
The COVID-19 pandemic changed diagnostic and treatment pathways in oncology. We compared the safety and efficacy of pembrolizumab amongst advanced nonsmall cell lung cancer (NSCLC) patients with a PD-L1 tumor proportion score (TPS) ≥ 50% before and during the pandemic.
Advanced NSCLC patients initiating pembrolizumab between June 2015 and December 2019 ("pre-pandemic cohort") and between March 2020 and March 2021 ("pandemic cohort") at BC Cancer were identified retrospectively. Multivariable logistic regression evaluated risk factors for immune-related adverse events (irAE) ≥ grade 3 at the 6 week, 3 month, and 6 month landmarks. Cox regression models of overall survival (OS) were constructed.
The study population comprised 417 patients in the pre-pandemic cohort and 111 patients in the pandemic cohort. Between March and May 2020, 48% fewer advanced NSCLC cases with PD-L1 TPS ≥ 50% were diagnosed compared to similar intervals in 2018-2019. Telemedicine assessment [new patient consultations (p < 0.001) and follow-up (p < 0.001)] and extended interval pembrolizumab dosing (p < 0.001) were more common in the pandemic cohort. Patients initiating pembrolizumab after February 2020 (vs. before January 2020) experienced similar odds of developing severe irAE. 2/111 (1.8%) patients receiving pembrolizumab during the pandemic tested positive for COVID-19. On multivariable analysis, no association between pembrolizumab treatment period (before vs. during the COVID-19 pandemic) and OS was observed (p = 0.18).
Significant changes in healthcare delivery in response to the pandemic did not result in increased high grade toxicity or lower survival outcomes in patients with advanced NSCLC treated with pembrolizumab.
COVID-19 大流行改变了肿瘤学的诊断和治疗途径。我们比较了 PD-L1 肿瘤比例评分（TPS）≥50%的晚期非小细胞肺癌（NSCLC）患者在大流行前后接受 pembrolizumab 治疗的安全性和疗效。
回顾性地确定了 2015 年 6 月至 2019 年 12 月（“大流行前队列”）和 2020 年 3 月至 2021 年 3 月（“大流行队列”）期间在 BC 癌症接受 pembrolizumab 治疗的晚期 NSCLC 患者。多变量逻辑回归评估了第 6 周、第 3 个月和第 6 个月时免疫相关不良事件（irAE）≥3 级的危险因素。构建了总生存期（OS）的 Cox 回归模型。
研究人群包括大流行前队列中的 417 名患者和大流行队列中的 111 名患者。与 2018-2019 年同期相比，2020 年 3 月至 5 月，PD-L1 TPS≥50%的晚期 NSCLC 病例诊断减少了 48%。远程医疗评估[新患者咨询（p<0.001）和随访（p<0.001）]和延长间隔 pembrolizumab 给药（p<0.001）在大流行队列中更为常见。与 2020 年 2 月之前（vs. 2020 年 1 月之前）开始接受 pembrolizumab 治疗的患者相比，发生严重 irAE 的几率相似。在大流行期间接受 pembrolizumab 治疗的 111 名患者中的 2 名（1.8%）新冠病毒检测呈阳性。多变量分析显示，pembrolizumab 治疗期（大流行前 vs. 大流行期间）与 OS 之间无关联（p=0.18）。
针对大流行，医疗保健的提供方式发生了重大变化，但接受 pembrolizumab 治疗的晚期 NSCLC 患者的高等级毒性或生存率没有降低。
