1113P Real-world multicentre cohort of 1L pembrolizumab alone or in combination with platinum-based chemotherapy in NSCLC PD-L1 ≥ 50%

Abstract

Pembrolizumab alone (IO) or with platinum-based chemotherapy (CT-IO) are 1L standard of care for advanced non-small cell lung cancer (NSCLC) patients with PD-L1 ≥ 50%. This retrospective, multicentre study assessed real-world use of both strategies. Patients with advanced NSCLC PD-L1 ≥ 50% were included if they received IO or CT-IO from 12-2019 (non-squamous) or 06-2020 (squamous), corresponding to the reimbursement date in France for each subtype. Disease characteristics were collected from 8 Hospitals. Overall survival (OS) and real-word progression-free-survival (rwPFS) were estimated using Kaplan-Meier methodology. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs, and a cox model with inverse propensity treatment weighting was carried out. Among the 243 patients included, 141 (58%) received IO and 102 (42%) CT-IO. Characteristics were detailed in the table. With a median follow-up of 11.5 months (95% CI, 10.4 – 13.3), median OS was not reached (NR) but no difference was observed between both groups (p=0.51). Early deaths at 3 months were 11% (95% CI 4.6 – 16.9) and 15.2% (95% CI 9.0 – 20.9) in CT-IO and IO groups (p=0.32). Median rwPFS was 11.3 months (95% CI 7.2 – NR) in CT-IO and 10.6 months (95% CI 7.1 – NR) in IO (p=0.76). After adjustment on age, ECOG, histology, brain metastases, liver metastases and tobacco status, no significant difference was found for OS between groups, neither in the multivariate [HR 1.07 (95% CI 0.61 – 1.86), p=0.8] nor in the propensity analysis [HR 0.99 (95% CI 0.60-1.65), p=0.99]. Same conclusion was done for rwPFS in the multivariate [HR 0.98 (95% CI 0.64 – 1.51), p=0.93] and the propensity analysis [HR 1.11 (95% CI 0.74-1.65), p=0.62].Table: 1113Pn (%)IO-mono (n=158)CT-IO (n=102)p-valueSex (Men)82 (58.2)57 (55.9)0.793Age, Median [range]68 [47 - 92]61 [35 - 81]<0.001ECOG 0 – 1106 (75.2)84 (82.3)0.209Smoking status Never Current or past12 (8.8) 124 (91.2)3 (3.0) 96 (97.0)0.104Histology Non-squamous115 (81.6)97 (95.1)0.002PDL1 90-100 50 - 8959 (41.8) 82 (58.2)49 (48.0) 53 (52.0)0.362Symptomatic disease at diagnosis Yes102 (72.3)90 (88.2)0.002Corticoids at diagnosis ≥ 10 mg/day < 10 mg/day None19 (13.8) 2 (1.4) 117 (84.8)22 (22.2) 1 (1.0) 76 (76.8)0.215Tumor stage Locally-advanced Metastatic26 (18.4) 115 (81.6)6 (5.9) 96 (94.1)0.004Only 1 M+ site50 (43.5)33 (34.3)0.006Brain M+26 (23.4)37 (39.4)0.003 Open table in a new tab Younger patients, those with a symptomatic disease and brain metastases were more prone to be proposed CT-IO. However, sparing the chemotherapy in 1L does not appear to impact survival outcomes, even regarding early deaths.