Jackson Ashley, Chang Nina, Akurang Deborah, Wheatley-Price Paul, Moore Sara
Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.
JTO Clin Res Rep. 2023 Nov 14;4(12):100601. doi: 10.1016/j.jtocrr.2023.100601. eCollection 2023 Dec.
Immunotherapy has vastly changed the treatment landscape for patients with advanced NSCLC. With high programmed death-ligand 1 (PD-L1) expression (tumor proportion score ≥50%), options include programmed cell death protein 1 or PD-L1 inhibitor with or without chemotherapy. A cut-point of greater than or equal to 50% defines PD-L1-high, but a more precise PD-L1 tumor proportion score may be an important predictor of outcomes.
We reviewed all patients with PD-L1-high NSCLC who received pembrolizumab from June 2019 to June 2021. Demographic, diagnosis, treatment, and outcomes data were collected retrospectively. The primary end point was a descriptive analysis of pembrolizumab prescribing patterns. Secondary end points included overall survival (OS) by treatment choice and absolute PD-L1 expression.
Overall, 132 patients received pembrolizumab; 124 (94%) as monotherapy, and 8 (6%) with chemotherapy. Baseline characteristics include the following: (1) median age 70 years (50-89); (2) 55% men; (3) 79% Eastern Cooperative Oncology Group performance status 0 to 1; and (4) 96% current or former smokers. There were 39% who have PD-L1 greater than or equal to 90% versus 61% with PD-L1 of 50% to 89%. The median OS in the overall population was 14.4 months. The median OS in the pembrolizumab monotherapy cohort and combination cohort were 13.6 months and 16.6 months, respectively ( = 0.67). Within the monotherapy cohort, the median OS was longer for PD-L1 greater than or equal to 90% (19.8 mo) versus PD-L1 50% to 89% (11.9 mo, = 0.039). The 24-month OS was 27.8% among patients with PD-L1 50% to 89% and 47.4% among patients with PD-L1 greater than or equal to 90%.
Most patients with advanced PD-L1-high NSCLC received pembrolizumab monotherapy, among whom OS was strongly correlated with PD-L1 expression, with PD-L1 greater than or equal to 90% of patients experiencing substantially longer survival. PD-L1 expression level could be an important determinant in immunotherapy prescribing patterns and a predictor of success in advanced NSCLC.
免疫疗法极大地改变了晚期非小细胞肺癌（NSCLC）患者的治疗格局。对于程序性死亡配体1（PD-L1）高表达（肿瘤比例评分≥50%）的患者，治疗选择包括程序性细胞死亡蛋白1或PD-L1抑制剂，可联合或不联合化疗。大于或等于50%的切点定义为PD-L1高表达，但更精确的PD-L1肿瘤比例评分可能是预后的重要预测指标。
我们回顾了2019年6月至2021年6月期间接受帕博利珠单抗治疗的所有PD-L1高表达NSCLC患者。回顾性收集人口统计学、诊断、治疗和预后数据。主要终点是对帕博利珠单抗处方模式的描述性分析。次要终点包括根据治疗选择和绝对PD-L1表达的总生存期（OS）。
总体而言，132例患者接受了帕博利珠单抗治疗；124例（94%）接受单药治疗，8例（6%）接受化疗。基线特征如下：（1）中位年龄70岁（50 - 89岁）；（2）55%为男性；（共3）79%的东部肿瘤协作组体能状态为0至1；（4）96%为当前或既往吸烟者。39%的患者PD-L1大于或等于90%，而61%的患者PD-L1为50%至89%。总体人群的中位OS为14.4个月。帕博利珠单抗单药治疗组和联合治疗组的中位OS分别为13.6个月和16.6个月（P = 0.67）。在单药治疗组中，PD-L1大于或等于90%的患者中位OS更长（19.8个月） vs PD-L1为50%至89%的患者（11.9个月，P = 0.039）。PD-L1为50%至89%的患者24个月OS率为27.8%，PD-L1大于或等于90%的患者为47.4%。
大多数晚期PD-L1高表达NSCLC患者接受了帕博利珠单抗单药治疗，其中OS与PD-L1表达密切相关，PD-L1大于或等于90%的患者生存期显著更长。PD-L1表达水平可能是免疫治疗处方模式的重要决定因素以及晚期NSCLC治疗成功的预测指标。
