Abstract
IntroductionThere are two treatment strategies for non-small cell lung cancer (NSCLC) exhibiting a high expression level of programmed death-ligand 1 (tumor proportion score ≥ 50%): pembrolizumab plus chemotherapy and monotherapy. We retrospectively compared their efficacy and safety.Materials and methodsWe reviewed the efficacy and safety of first-line pembrolizumab-containing regimens administered between 2017 and 2020 to consecutive patients. The patients were divided into a pembrolizumab plus chemotherapy group (Combo group) or monotherapy group (Mono group). To compare the efficacy, we monitored the time to failure of strategy (TFS) defined as the time from the start of treatment to the occurrence of one of the following events: the addition of any drug not included in the primary strategy, progression of cancer after complete therapy, progression and no subsequent therapy, or death, whichever occurred first. We used the propensity score matching (PSM) to reduce the bias.ResultsA total of 126 patients were identified (89 in the Mono group and 37 in the Combo group). PSM matched 36 individuals from each of the two groups. The overall response rate and median progression-free survival of the Combo group were better than those of the Mono group. However, the median TFS was almost the same (11.3 months vs. 14.9 months; hazard ratio 1.40 [95% confidence interval 0.62–3.15]). The frequency of all serious adverse effects was higher in the Combo group than in the Mono group.DiscussionDue to similar efficacy in TFS, both pembrolizumab plus chemotherapy and monotherapy are valid options for NSCLC.
Highlights
There are two treatment strategies for non-small cell lung cancer (NSCLC) exhibiting a high expression level of programmed death-ligand 1: pembrolizumab plus chemotherapy and monotherapy
There is no clear consensus on whether pembrolizumab monotherapy followed by chemotherapy or combined pembrolizumab plus chemotherapy is superior for the treatment of advanced NSCLC with PD-L1 TPS ≥ 50%
The combination of pembrolizumab plus chemotherapy or pembrolizumab monotherapy followed by chemotherapy demonstrated a similar to failure of strategy (TFS) and overall survival (OS) for patients with advanced NSCLC exhibiting a high PD-L1 TPS
Summary
There are two treatment strategies for non-small cell lung cancer (NSCLC) exhibiting a high expression level of programmed death-ligand 1 (tumor proportion score ≥ 50%): pembrolizumab plus chemotherapy and monotherapy. We retrospectively compared their efficacy and safety. Discussion Due to similar efficacy in TFS, both pembrolizumab plus chemotherapy and monotherapy are valid options for NSCLC. Several trials have demonstrated the efficacy of pembrolizumab, an immune checkpoint inhibitor, in patients with advanced non-small cell lung cancer (NSCLC) exhibiting a high expression level of programmed death-ligand 1 (PDL1) (tumor proportion score [TPS] ≥ 50%) [1,2,3,4]. The significance of combining chemotherapy is not clear when comparing these results
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