Nivolumab or Atezolizumab in the Second-Line Treatment of Advanced Non-Small Cell Lung Cancer? A Prognostic Index Based on Data from Daily Practice

Abstract

Background: The efficacy of nivolumab and atezolizumab in advanced pre-treated NSCLC was documented in prospective trials. We aim to confirm the benefits and indicate predictive factors for immunotherapy in daily practice. Methods: This study was a retrospective analysis. The median PFS and OS were estimated using the Kaplan-Meier method. The log-rank test was used for comparisons. Multivariate analyses were performed using the Cox regression method. Results: A total of 260 patients (ECOG 0-1) with advanced NSCLC (CS III-IV) were eligible to receive nivolumab or atezolizumab as second-line treatment. Median PFS and OS were three months (95% confidence interval [CI] 2.57–3.42) and 10 months (95% CI 8.03–11.96), respectively, for the overall population. The median OS for the atezolizumab arm was eight months (95% CI 5.89–10.1), while for the nivolumab group, it was 14 months (95% CI 10.02–17.97) (p = 0.018). The sum of all measurable changes >100.5 mm (p = 0.007; HR = 1.003, 95% CI 1.001–1.005), PLT > 281.5 G/l (p < 0.001; HR = 1.003, 95% CI 1.001–1.003) and bone metastases (p < 0.004; HR = 1.58, 95% CI 1.04–2.38) were independent negative prognostic factors for OS in multivariate analysis. Based on preliminary analyses, a prognostic index was constructed to obtain three prognostic groups. Median OS in the subgroups was 16 months (95% CI 13.3–18.7), seven months (95% CI 4.83–9.17) and four months (95% CI 2.88–5.13), respectively (p < 0.001). Conclusions: Nivolumab and atezolizumab provided clinical benefit in real life. Clinical and laboratory factors may help to identify subgroups likely to benefit. The use of prognostic indices may be valuable in clinical practice.

Atezolizumab Monotherapy for Non-small Cell Lung Cancer Patients: An Observational Study in Ibaraki Group (ATTENTION-IBARAKI)

“…Several studies have performed multivariate analyses on prognostic factors in ICI monotherapy. Most were studies on anti-PD-1 antibodies, and adverse factors cited included poor PS, low PD-L1, epidermal growth factor receptor positivity, tumor size, increased platelets, and bone metastasis (7)(8)(9). Only the report by Furuya et al evaluated prognostic factors for an anti-PD-L1 antibody.…”

“…Atezolizumab, like other anti-PD-1 antibodies, was initially used as a monotherapy, but has become popular in combination with chemotherapy (5,6). Real-world clinical data for immune checkpoint inhibitor (ICI) monotherapy for NSCLC have been reported from several institutes (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, most were reports on anti-PD-1 antibodies, such as nivolumab and pembrolizumab (8-11, 17, 18).…”

“…However, most were reports on anti-PD-1 antibodies, such as nivolumab and pembrolizumab (8-11, 17, 18). Although there have been studies on ICI monotherapy, including atezolizumab (7,(12)(13)(14)(15)(16), detailed clinical outcomes for patients treated with atezolizumab monotherapy have been limited (7,12,16). To the best of our knowledge, there have been only two reports on clinical outcomes for atezolizumab monotherapy, both with cohorts of less than 50 patients (12,16).…”