Abstract
ObjectivesThe effectiveness of treatment after cessation of nivolumab in patients with advanced non-small cell lung cancer (NSCLC) has not been well investigated. The aim of the present study was to clarify the clinical benefit of post-nivolumab treatment in such patients.Materials and methodsA retrospective review was conducted on patients who received treatment after cessation of nivolumab due to disease progression or adverse events at the Toneyama National Hospital between January 2016 and April 2017.ResultsAmong 64 patients treated with nivolumab, 26 patients received treatment after cessation of nivolumab due to disease progression (n = 21) or adverse events (n = 5). The median age of the patients was 68 years and 19 patients were male. Nineteen patients had performance status (PS) 1 or less at initiation of post-nivolumab treatment. Four, 20, and 2 patients were treated with platinum doublets, a single agent, and molecular targeting agents, respectively. Response rate, disease control rate, and median progression-free survival of first-line post-nivolumab treatment were 34.6% (9 patients), 73.1% (19 patients), and 2.8 months (95% confidence interval [CI]: 1.7–5.2), respectively. Adverse events (≥ grade 3) and treatment cessation were observed in 57.7% (15 patients) and 19.2% (5 patients), respectively. There were no statistically significant differences for the majority of patient characteristics between the groups with (n = 26) and without post-nivolumab treatment. However, PS at cessation of nivolumab and post-progression survival (PPS) after cessation of nivolumab (median PPS: 12.6 vs. 1.4 months, 95% CI: 3.8–14.7 vs. 0.4–2.2) were significantly different between the groups. A multivariate Cox regression analysis showed significant correlation of PS at cessation of nivolumab (hazard ratio [HR]: 0.34, 95% CI: 0.13–0.87) and post-nivolumab treatment (HR: 0.19, 95% CI: 0.08–0.43) with prolonged PPS after nivolumab.ConclusionMedian post-progression survival in patients with advanced NSCLC who received post-nivolumab treatment was approximately 1 year.
Highlights
Lung cancer is one of the leading causes of mortality worldwide
Among 64 patients treated with nivolumab, 26 patients received treatment after cessation of nivolumab due to disease progression (n = 21) or adverse events (n = 5)
performance status (PS) at cessation of nivolumab and post-progression survival (PPS) after cessation of nivolumab were significantly different between the groups
Summary
Cytotoxic chemotherapy has been the standard treatment of this disease for decades Molecular targeting agents such as gefitinib, one of the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), became available one and half decade ago. Numerous pivotal studies showed a survival benefit of treatment with nivolumab in patients with NSCLC [1, 2]. The efficacy of pembrolizumab as first-line therapy in NSCLC patients with high programmed death ligand 1 (PD-L1) expression has been reported [4]. These results emphasized the importance of PD-1 inhibitors in the treatment of lung cancer and drastically altered the therapeutic strategy against this disease
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