Immunotherapy at any line of treatment improves survival in patients with advanced metastatic non‐small cell lung cancer (NSCLC) compared with chemotherapy (Quijote‐CLICaP)

Abstract

Background: To compare survival outcomes of patients with advanced or metastatic non-small cell lung cancer (NSCLC) who received immunotherapy as first-, second-or beyond line, versus matched patients receiving standard chemotherapy with special characterization of hyperprogressors. Methods: A retrospective cohort study of 296 patients with unresectable/metastatic NSCLC treated with either, first-, second-, third-or fourth-line of immunotherapy was conducted. A matched comparison with a historical cohort of first-line chemotherapy and a random forest tree analysis to characterize hyperprogressors was conducted. Results: Median age was 64 years (range 34-90), 40.2% of patients were female. A total of 91.2% of patients had an Eastern Cooperative Oncology Group (ECOG) performance score ≤ 1. Immunotherapy as first-line was given to 39 patients (13.7%), second-line to 140 (48.8%), and as third-line and beyond to 108 (37.6%). Median overall survival was 12.7 months (95% CI 9.67-14 months) and progression-free survival (PFS) of 4.27 months (95% CI 3.97-5.0). Factors associated with increased survival included treatment with immunotherapy as first-line (P < 0.001), type of response (P < 0.001) and PD-L1 status (P = 0.0039). Compared with the historical cohort, immunotherapy proved to be superior in terms of OS (P = 0.05) but not PFS (P = 0.2). A total of 44 hyperprogressors were documented (19.8%,.1%]). Leukocyte count over 5.300 cells/dL was present in both hyperprogressors and long-term responders. Conclusions: Patients who receive immune-checkpoint inhibitors as part of their treatment for NSCLC have better overall survival (OS) compared with matched patients treated with standard chemotherapy, regardless of the line of treatment.

Impact of the corticosteroid indication and administration route on overall survival and the tumor response after immune checkpoint inhibitor initiation

“…lung and renal cancers). 1 – 3 However, up to 60–80% of treated patients fail to responds to immunotherapy. 4 Several escape mechanisms have been identified.…”

Targeting Immunometabolism Mediated by CD73 Pathway in EGFR-Mutated Non-small Cell Lung Cancer: A New Hope for Overcoming Immune Resistance

“…The use of immune checkpoint inhibitors (ICIs) has revolutionized the management of patients with non-oncogene addicted NSCLC in both first-and second-line settings, showing an unexpected long-term effectiveness and a good toxicity profile (11); on the other hand, to date the clinical outcomes of ICIs in oncogene-addicted NSCLC are disappointing.…”

Antibiotics impair immune checkpoint inhibitor effectiveness in Hispanic patients with non‐small cell lung cancer (AB‐CLICaP)

“…Non-small cell lung cancer (NSCLC), the first cause of cancer related deaths worldwide, has been a prime example of the widespread implementation of these drugs in the treatment of both locally-advanced and metastatic stages as first, second or further lines. [1][2][3][4][5][6] Despite the improved overall survival (OS) rates observed with anti PD-L1 ICIs in lung cancer, there are a significant number of patients who do not reap a clinical benefit from this therapeutic strategy. Several factors such as innate resistance mechanisms including the absence of PD-L1 expression, 7 low tumor mutational burden (TMB), 8 STK11/LKB1 mutations, 9 among others can deter the expected response to these agents.…”