Real-world PD-L1 testing, fi rst-line therapy for advanced NSCLC, and fi rst-line pembrolizumab monotherapy utilization and outcomes for metastatic NSCLC in the Czech Republic.

BACKGROUND

This study aimed to describe real-world PD-L1 testing and first-line (1L) treatment patterns for advanced non-small cell lung cancer (NSCLC), and clinical outcomes for metastatic NSCLC after 1L pembrolizumab monotherapy became reimbursed in the Czech Republic (February 2019).

PATIENTS AND METHODS

This descriptive noninterventional study drew on two Czech lung cancer registries. We examined PD-L1 testing patterns and results in the KELLY registry for samples submitted on/after 1-Feb-2019 from adult patients with advanced NSCLC. Using the TULUNG registry, we summarized 1L targeted therapies initiated on/after 1-Feb-2019 for advanced NSCLC, in addition to characteristics and outcomes for patients treated with 1L pembrolizumab monotherapy for metastatic NSCLC, PD-L1 tumor proportion score (TPS) ≥ 50%, and no known EGFR/ALK alterations. Real-world time on treatment (rwToT) and overall survival (OS) were determined using Kaplan-Meier curves. The data cutoff was 16-Sept-2021.

RESULTS

The percentage of NSCLC samples in the KELLY registry tested for PD-L1 expression increased from 70.5% in 2019 to 84.4% in 2021. Pembrolizumab monotherapy was the most common 1L targeted therapy in 2019-2021 for patients with advanced NSCLC and PD-L1 TPS ≥ 50% (N = 315), administered to 70-80% each year. Of 235 patients with metastatic NSCLC who received 1L pembrolizumab monotherapy, median age was 69 years, 54% were men, 52% were current smokers, and 28% had squamous NSCLC. Median rwToT was 8.5 months (95% CI; 6.7-10.1), with 6- and 12-month on-treatment rates of 59% and 36%, respectively, for 199 patients with ≥ 6 months of follow-up. With added national registry mortality data, estimated median OS was 13.7 months (12.3-17.7); 6- and 12-month OS rates were 70% and 59%, respectively.

CONCLUSIONS

The rates of PD-L1 testing increased from 2019 to 2021. Median OS among patients with metastatic NSCLC and PD-L1 TPS ≥ 50% treated with pembrolizumab was lower than in clinical trials, likely due to differences between real-world patients and trial participants in age, smoking status, performance status, and squamous histology.