Abstract
Pembrolizumab represents a first-line option for advanced NSCLC with high PD-L1 expression (≥50%). However, several factors such as antibiotic-exposure, low body mass index (BMI), bone metastases, or ECOG-PS of 2, may influence outcomes from fist-line pembrolizumab. We have evaluated the association between those factors with survival in a cohort of patients with stage IV high PD-L1 expression NSCLC consecutively treated with first-line pembrolizumab. We included 104 patients between May 2011 and January 2022. The median follow-up was 16.32 months (m) [1.71 – 63.90]. Median age was 68 years (y) (45-86), 75% were male, 26% were current smokers, 23.1% had ECOG-PS2, 40.4% BMI<25, 6.7% antibiotic-exposure, 33.7% received a corticosteroid dose higher than the equivalent to 10mg of prednisone (>10mg PDNe), 57.7% Proton Pump Inhibitors and 83.7% received treatment beyond progression. 7.7% had complete response (CR) as best response, 43.3% had partial response (PR), 15.2% had steable disease (SD), 22.1% had progression disease (PD). Overall Response Rate (ORR): 51%. The median OS and PFS in the overall population were 22.1 m (95% CI, 11.2-33.0) and 11.84 m (95% CI, 4.49-19.19), respectively. The median OS in patients with a ECOG 0-1, CR/PR as best response, receiving treatment beyond progression and without corticosteroid exposure was significantly longer (p<0.0001) (Table). No differences in OS were observed according to the use of Proton Pump Inhibitors, BMI or smoking habit.Table: 1098PECOG-PSMedian OSp-valueMedian PFSp-value0Not reached (NR)26.03 (11.81-40.26)124.55 (18.34-30.76)14.45 (3.48-25.43)22.13 (1.39-2.87)<0.00010.71 (0.42-1.00)<0.0001>10mg PDNeYes3.13 (0.0-9.33)3.94 (1.26-6.61)No24.55 (19.77-29.33)0.00316.32 (7.71-24.94)0.100Proton Pump Inhibitor exposureYes13.71 (1.75-25.67)16.32 (3.95-28.70)No24.55 (4.87-44.22)0.20511.84 (3.71-19.96)0.939Best responseCRNRNRPRNR32.45 (19.82-45.08)SD11.87 (8.50-15.24)4.42 (2.80-6.04)PD4.77 (2.20-7.35)<0.00012.68 (0.0-5.56)<0.0001Treatment beyond progressionYes31.84 (13.49-50.19)14.45 (3.44-25.47)No10.74 (8.54-12.94)0.0013.94 (2.52-5.35)0.001 Open table in a new tab ECOG 0-1, not receiving exposure, CR/PR as best response and receiving treatment beyond progression were predictive of better outcome to pembrolizumab in advanced NSCLC patients with high PD-L1 expression.
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