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Abstract
Simple SummaryLung cancer is the leading cause of cancer-related death in the United States (US), and real-world studies are needed to understand effectiveness of cancer therapies for patients treated outside of cancer clinical trials. Pembrolizumab, an immunotherapy agent that aids the body’s immune system in fighting cancer, is administered for up to 2 years when treating advanced non-small cell lung cancer (NSCLC). We evaluated the real-world time on treatment (rwToT), a surrogate indicator that has been associated with survival in NSCLC studies, for over 1000 patients with advanced NSCLC treated initially with pembrolizumab at US oncology clinics. The median rwToT for patients with good performance status (similar to those in clinical trials) was 7.4 months, consistent with the median treatment duration in the KEYNOTE-024 trial (7.9 months). Our findings suggest long-term benefit of first-line pembrolizumab for patients with advanced NSCLC and good performance status at the start of therapy who are treated in real-world settings.Our aim was to evaluate real-world time on treatment (rwToT), overall and by KRAS mutation status, with first-line pembrolizumab monotherapy for advanced non-small cell lung cancer (NSCLC) in real-world oncology practice in the US. rwToT is a readily available, intermediate-range endpoint that is moderately to highly correlated with overall survival in clinical trials and real-world data. Using deidentified electronic medical record data, we studied patients with ECOG performance status (PS) of 0–2 who initiated pembrolizumab (1 November 2016 to 31 March 2020) for advanced NSCLC with programmed death-ligand 1 (PD-L1) expression ≥ 50% and without EGFR/ALK/ROS1 genomic alterations. The data cutoff was 31 March 2021, and the median study follow-up was 34 months. The Kaplan–Meier median rwToT with first-line pembrolizumab monotherapy was 7.4 months (95% CI, 6.3–8.1) for 807 patients with PS 0–1, which was consistent with the median treatment duration in the KEYNOTE-024 trial (7.9 months). The median rwToT for 237 patients with PS 2 was 2.1 months (95% CI, 1.4–2.8). For those with KRAS-mutated and KRAS wild-type nonsquamous NSCLC and PS 0–1, the median rwToT was 7.6 months and 7.0 months, respectively. Our findings suggest long-term benefit of first-line pembrolizumab monotherapy for advanced NSCLC with PD-L1 expression ≥ 50% in real-world settings in the US, particularly for patients with good performance status at the start of therapy, irrespective of KRAS status.
Highlights
Lung cancer is the third most common cancer in the United States (US), often presenting at late stages
We identified 1044 patients with ECOG performance status (PS) of 0–2 who were treated with first-line pembrolizumab monotherapy for advanced non-small cell lung cancer (NSCLC) with PD-ligand 1 (PD-L1) expression ≥ 50% and no recorded EGFR/ALK/ROS1 genomic alteration, including 807 patients (77%) with Eastern Cooperative Oncology Group performance status (ECOG PS) of 0–1 and 237 (23%) with ECOG PS of 2 (Figure 1)
Patients with good performance status (ECOG PS 0–1) treated in the US real-world clinical setting for advanced NSCLC, with PD-L1 TPS ≥ 50%, and without EGFR/ALK/ROS1 genomic alterations, experienced a median real-world time on treatment (rwToT) of 7.4 months, similar to the treatment durations observed in clinical trials
Summary
Lung cancer is the third most common cancer in the United States (US), often presenting at late stages While it remains the leading cause of cancer-related deaths in both men and women [1], declines in mortality from lung cancer have been recorded in the past decade [2,3]. The choice of first-line systemic anticancer therapy for unresectable advanced NSCLC is guided by tumor histology, biomarkers (e.g., tumor PD-L1 expression), and whether targetable genomic alterations are present, in addition to patient clinical status and preferences [4–6]. For patients who have unresectable advanced or metastatic NSCLC with PD-L1 expression ≥ 50% and no targetable genomic alterations, the preferred first-line therapies listed in US National Comprehensive Cancer Network (NCCN) guidelines include pembrolizumab, atezolizumab, or cemiplimab-rwlc as monotherapy or pembrolizumabcombination therapy, the latter chosen according to NSCLC histopathology [7]. Continued (maintenance) therapy, chosen according to initial ICI therapy, is recommended until disease progression or unacceptable toxicity (or for up to 2 years in the case of pembrolizumab) [7]
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