Real-World Outcomes for Advanced Non-Small Cell Lung Cancer Patients Treated With a PD-L1 Inhibitor Beyond Progression

Abstract

BackgroundClinical trials of anti-programmed cell death ligand 1 (PD-L1) inhibitor to treat advanced non–small-cell lung cancer (aNSCLC) have permitted treatment beyond progression (TBP). However, the outcomes of patients receiving TBP in routine clinical care are unknown. Materials and MethodsThe present retrospective, observational, multicenter analysis evaluated de-identified electronic health record-derived data from community-based clinics in the United States. The patients had confirmed aNSCLC, had started anti–PD-L1 inhibitor therapy (nivolumab, pembrolizumab, or atezolizumab) before October 1, 2018, and had experienced a real-world progression (rwP) event. The study period ended March 31, 2019. The primary objective was to compare the overall survival (OS) of patients who had discontinued immunotherapy ≤ 30 days (non-TBP) compared with > 30 days after rwP (TBP). Descriptive analyses were performed. The Kaplan-Meier method and log-rank test were conducted for OS. An adjusted multivariable Cox proportional hazards regression model was also used. ResultsOverall, the data from 4223 patients were analyzed; 2555 (60.5%) and 1668 (39.5%) in the non-TBP and TBP cohorts, respectively. The median treatment duration for the non-TBP and TBP patients was 2.8 and 9.1 months (log-rank test, P < .001), respectively. The TBP group experienced longer unadjusted OS compared with the non-TBP group (11.5 vs. 5.1 months; log-rank test, P < .001). After adjusting for clinically relevant patient characteristics, the TBP OS benefit persisted (adjusted hazard ratio, 0.69; P < .001). ConclusionsTBP with PD-L1 inhibitor therapy is common in aNSCLC routine care and is potentially effective. These results support clinical trial observations likely to affect practice patterns.