Regeneron Pharmaceuticals, Inc., 1 Rockwood Road, Sleepy Hollow, NY, 10591, USA.
Genesis Research, LLC, Hoboken, NJ, USA.
Adv Ther. 2022 Oct;39(10):4645-4662. doi: 10.1007/s12325-022-02260-9. Epub 2022 Aug 10.
Contemporary real-world data on advanced non-small cell lung cancer (aNSCLC) treatment patterns across programmed cell death-ligand 1 (PD-L1) expression levels and testing status are limited.
A retrospective cohort was selected of adults newly diagnosed with aNSCLC between January 1, 2018, and July 31, 2021, who initiated first-line treatments, which were described by PD-L1 status and expression levels (≥ 50%, 1-49%, < 1%). Treatment received before and after PD-L1 test results were described for patients initiating first-line treatment before PD-L1 results. For patients who initiated chemotherapy alone before PD-L1 results, the probability of receiving immune checkpoint inhibitors (ICIs) after PD-L1 results was estimated by PD-L1 level and associated factors were explored.
Among 12,202 patients with aNSCLC initiating first-line treatment [54.7% male, mean (standard deviation) age 69.2 (9.4) years], the most common therapies were ICI-based regimens across PD-L1 levels, and chemotherapy alone among PD-L1-untested patients. Use of chemotherapy alone decreased between 2018 and 2019 and stabilized thereafter, accounting for 21-29% of first-line treatments across PD-L1 levels and 48% of untested patients in 2021. Of 1468 patients initiating first-line treatment before PD-L1 results, treatments remained unchanged in most patients after PD-L1 results. Among patients initiating chemotherapy alone before PD-L1 results, the probability of receiving ICIs within 45 days after test results was 40.5% [95% confidence interval (CI) 31.6-48.3%], 28.6% (95% CI 20.3-36.0%), and 22.9% (95% CI 16.9-28.4%) at PD-L1 ≥ 50%, 1-49%, and < 1%, respectively.
While ICI-based regimens accounted for most first-line treatments across PD-L1 levels, chemotherapy alone was initiated in > 20% of patients tested for PD-L1 and 48% of untested patients in 2021. Patients who initiated chemotherapy alone had a low probability of receiving ICIs after PD-L1 test results. These results highlight the need for understanding the role and timing of PD-L1 test results for informing treatment decisions for patients with aNSCLC.
程序性细胞死亡配体 1（PD-L1）表达水平和检测状态下的晚期非小细胞肺癌（aNSCLC）治疗模式的当代真实世界数据有限。
回顾性队列纳入 2018 年 1 月 1 日至 2021 年 7 月 31 日期间新诊断为 aNSCLC 的成年患者，他们接受了一线治疗，一线治疗按 PD-L1 状态和表达水平（≥50%、1-49%、<1%）进行描述。对于在 PD-L1 结果之前开始一线治疗的患者，描述了在 PD-L1 测试结果之前和之后接受的治疗。对于在 PD-L1 结果之前仅接受化疗的患者，根据 PD-L1 水平估计了 PD-L1 结果后接受免疫检查点抑制剂（ICI）的概率，并探讨了相关因素。
在 12202 名接受一线治疗的 aNSCLC 患者中[54.7%为男性，平均（标准差）年龄 69.2（9.4）岁]，最常见的治疗方案是 PD-L1 水平下的基于 ICI 的治疗方案，以及 PD-L1 未检测患者中单独化疗。2018 年至 2019 年间，单独化疗的使用率下降，此后趋于稳定，在各 PD-L1 水平下占一线治疗的 21-29%，在 2021 年占未检测患者的 48%。在 PD-L1 结果之前开始一线治疗的 1468 名患者中，大多数患者在 PD-L1 结果后治疗方案保持不变。在 PD-L1 结果之前仅接受化疗的患者中，在测试结果后 45 天内接受 ICI 的概率分别为 40.5%（95%置信区间 31.6-48.3%）、28.6%（95%置信区间 20.3-36.0%）和 22.9%（95%置信区间 16.9-28.4%），PD-L1≥50%、1-49%和<1%。
虽然基于 ICI 的治疗方案在各 PD-L1 水平下占大多数一线治疗，但在 2021 年，PD-L1 检测患者中仍有超过 20%和未检测患者中 48%接受了单独化疗。仅接受化疗的患者在 PD-L1 检测结果后接受 ICI 的可能性较低。这些结果强调了需要了解 PD-L1 检测结果的作用和时机，以便为 aNSCLC 患者的治疗决策提供信息。
