Pembrolizumab Plus Chemotherapy or Anlotinib vs. Pembrolizumab Alone in Patients With Previously Treated EGFR-Mutant NSCLC

Abstract

ObjectivesMore and more encouraging evidence revealed that immunotherapy could improve clinical outcomes in patients with previously treated non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) variations. However, immunotherapy is still a controversy for NSCLC patients with EGFR mutation.MethodIn this retrospective analysis, we compared the clinical efficacy of pembrolizumab monotherapy (PM), pembrolizumab combined with chemotherapy (P+C) and pembrolizumab combined with anlotinib (P+A) in NSCLC patients with EGFR mutation who had failed on EGFR-TKI and platinum-based chemotherapy.ResultEighty-six patients were included in this study. The overall median progression free survival (PFS) was 3.24 months. Multivariate analysis suggested that EGFRL858R and combined therapy were positive prognostic factors of PFS. The overall median OS was 12.28 months. Multivariate analysis found that high PD-L1 expression (≥50%) and combined therapy seemed to be positive prognostic factors of OS. Among the population, 32 patients received PM, 26 patients received P+C and 28 patients received P+A. Up to Jan 30, 2021, the median progression-free survival was 1.5 months in the PM group, 4.30 months in the P+C group and 3.24 months in the P+A group. The median OS were 7.41, 14.92 and 15.97 months, respectively. The ORR were 3.1%, 23.1% and 21.4%.ConclusionThe addition of chemotherapy or antiangiogenic therapy to pembrolizumab resulted in significantly longer PFS, OS and ORR than pembrolizumab alone in our study. EGFRL858R might be a positive prognostic factor of PFS and high PD-L1 expression might be a positive prognostic factor of OS.

The real-world efficacy and safety of anlotinib in advanced non-small cell lung cancer

“…This finding supports the hypothesis of the synergistic effect of anti-angiogenic therapy and immunotherapy, which is likely through significant improving the migration of antigen-specific T cell by the vascular normalization (Wallin et al 2016). This good survival is comparable to those reported in two recent studies on the combination of anlotinib with ICIs, with a PFS of 15 months in patients with untreated wild-type aNSCLC and an OS of 15.97 months in patients with previously treated EGFRmutant aNSCLC, respectively (Chen et al 2021;Chu et al 2021).…”

Global research landscape and trends of lung cancer immunotherapy: A bibliometric analysis

“…A retrospective analysis compared pembrolizumab plus chemotherapy or anlotinib with pembrolizumab alone for previously treated EGFR–mutated NSCLC. The combined therapy resulted in a significantly better prognosis than monotherapy ( 44 ).…”

The application basis of immuno-checkpoint inhibitors combined with chemotherapy in cancer treatment

“…Among them, 83% are ICIs combined with other therapies, such as chemotherapy, radiotherapy, and other immuno-oncology therapies ( 16 ). Several clinical trials show that ICIs combined with chemotherapy have a better clinical effect compared to ICIs monotherapy ( 17 – 19 ). For example, pembrolizumab, a humanized monoclonal antibody against PD-1, plus platinum-based chemotherapy significantly improved overall survival rates of NSCLC patients with a PD-L1 ≥ 50% and negative for genomic alterations in the EGFR and ALK genes, compared with pembrolizumab monotherapy ( 19 ).…”