Real-world progression-free survival in first-line advanced non-small cell lung cancer treated with immunotherapy-based regimens using a US dataset

Abstract

While results from clinical trials are important in determining the efficacy of treatment, restrictive eligibility criteria may limit generalizability to patient populations in the real-world setting. Real-world analyses can therefore identify subgroups of patients who may respond differently to specific therapeutic regimens. This supplementary data is supportive to the research article entitled “Real-world outcomes of immunotherapy–based regimens in first-line advanced non-small cell lung cancer” [1] . Using electronic health records data from a large demographically and geographically diverse oncology database, we present real-world progression-free survival (rwPFS) outcomes for patients with advanced non-small cell lung cancer in the United States treated with either first-line immunotherapy as monotherapy or single-agent immunotherapy combined with chemotherapy. rwPFS was estimated for patients in each treatment group using Kaplan-Meier methods; analyses were conducted separately for patients with squamous and non-squamous histology and stratified by Eastern Cooperative Oncology Group performance status, tumor programmed death ligand-1 expression, and presence of brain metastases.

Pembrolizumab-combination therapy for previously untreated metastatic nonsquamous NSCLC: Real-world outcomes at US oncology practices

“…In KEYNOTE-189, the benefits of pembrolizumab-combination therapy, as compared with placebo-combination therapy, were observed irrespective of PD-L1 expression. We found, similar to Waterhouse et al (13), that survival was longer for patients with nonsquamous NSCLC with PD-L1 expression ≥50%, among whom median OS was 20.6 months (95% CI, 16.2-26.8), while for those with PD-L1 <1%, median OS was 13.2 months (95% CI, 10.9-19.9). In addition, there were other differences between the PD-L1 ≥50% vs. PD-L1 <1% cohorts in the present study, namely, the median rwPFS was longer for the PD-L1 ≥50% cohort (9.3 months vs. 5.0 months for PD-L1 <1%), and at 24 months, more patients remained on pembrolizumab therapy (18.4% vs. 9.4%, respectively), while therapyrelated adverse events resulting in pembrolizumab discontinuation were slightly greater for the PD-L1 ≥50% cohort (21.1% vs. 14.8%, respectively).…”

“…In clinical settings, physicians may have a lower threshold to stop or change therapy in response to minor imaging changes, and perhaps associated clinical deterioration. In a recent US observational study of patients with nonsquamous advanced NSCLC who received first-line immunotherapychemotherapy and had an ECOG PS 0-1, the reported median OS was 14.2 months, somewhat shorter than in the present study (17.2 months), and estimated 12-month and 24-month OS rates were 54.8% and 36.8% (vs. 59.4% and 39.2% in the present study) (13). However, that study, which also drew on the Flatiron Health database, included patients with unknown EGFR/ALK mutation status (~18%) and had median follow-up of only 6.5 months.…”

“…The Kaplan-Meier median duration of first-line immunotherapychemotherapy (5.6 months) was similar to that in the present study (median rwToT, 5.8 months). The authors identified older age, ECOG PS >1, and presence of brain metastases as being associated with poorer survival outcomes, and PD-L1 expression of ≥50% as being associated with longer median OS (vs. low expression) (13). For an older US population (ages 66-89) of 1495 patients with advanced NSCLC, Kehl et al ( 19) reported median OS of 12.9 months (95% CI, 11.8-14.0) with pembrolizumab-pemetrexedplatinum-based chemotherapy.…”

“…The efficacy of this combination regimen is supported by KEYNOTE-189 and -021 clinical trial results demonstrating superior overall survival (OS) for patients with advanced or metastatic nonsquamous NSCLC and no EGFR or ALK genomic aberrations who were treated with first-line pembrolizumab plus pemetrexed-platinum as compared with placebo plus pemetrexed-platinum (8)(9)(10)(11)(12). To date, however, a limited number of published studies have assessed survival outcomes of real-world patient populations treated with first-line immunotherapy-chemotherapy combinations in the US (13)(14)(15)(16)(17)(18)(19)). An earlier study reported the effectiveness of first-line pembrolizumab plus pemetrexed-carboplatin for 283 patients with metastatic nonsquamous NSCLC treated at US oncology clinics: median OS was 16.5 months, and the 12-month survival rate was 59.5% (17).…”

[Retracted] Effect of Family Participatory Nursing Model Based on WeChat Platform on Psychological Elasticity and Quality of Life of Patients with Lung Cancer

“…Lung cancer accounts for 21.3% and 27.1% of the total morbidity and mortality of all kinds of cancers, respectively [ 5 , 6 ]. The morbidity increases with age, and the mortality rate of males is higher compared to females, and the mortality rate of males is higher compared to females, and that of rural areas is higher compared to urban areas [ 7 , 8 ]. Although the diagnosis and treatment of lung cancer are gradually standardized in our country, there is a lack of effective screening methods and most of the patients with early lung cancer have no significant symptoms, and most of the patients are diagnosed in the middle and late stage.…”