Abstract
BackgroundPatients treated with immunotherapy in the real-world may have significantly different responses to those meeting inclusion criteria for random controlled clinical studies. There is a partial overlap in approved indications for the use of the different immune checkpoint inhibitors (ICIs) currently available. A comprehensive assessment of the efficacy, safety and economic effects of various ICIs is a problem that clinicians need to address.MethodsAnalyzed real-world data was collected from non-small cell lung cancer (NSCLC) patients who were treated with ICIs from hospitalized patients in the Lung Cancer Center of Peking Union Medical College Hospital between 2018 and 2021. The objectives were to evaluate the efficacy and safety of different ICIs for the treatment of NSCLC in China and to investigate the factors affecting their curative effects.ResultsOverall, 351 patients were included in the retrospective study. The median PFS for the NSCLC patient cohort treated with medication regimens that included ICIs was 9.5 months, with an ORR of 47.3%. There were no significant discrepancies in efficacy and safety between the different ICIs administered. Factors that had the greatest impact on the efficacy of ICIs were the disease stage, ECOG-PS scores and treatment lines. Gender, age, smoking history, PD-L1 TPS expression, history of targeted therapy and irAEs all had a degree of influence on patient prognosis.ConclusionsThe study reports the experience of real-world usage of ICIs for the treatment of NSCLC patients in China. The results were generally consistent with those of clinical trials, while the efficacy and safety of different ICIs exhibited no statistically significant differences. Therefore, physicians can make a comprehensive choice based on the indications and cost of different ICIs and the preferences of patients.
Highlights
Patients treated with immunotherapy in the real-world may have significantly different responses to those meeting inclusion criteria for random controlled clinical studies
The type of immune checkpoint inhibitors (ICIs) used for non-small cell lung cancer (NSCLC) was predominantly pembrolizumab (65.2%), with the remaining therapy including nivolumab (5.1%), camrelizumab (6.0%), tislelizumab (6.8%) and sintilimab (7.7%)
ICIs, immune checkpoint inhibitors; PFS, progression-free survival; HR, hazard ratio; 95% confidence intervals (CIs), 95% confidence interval; ORR, objective response rate; odds ratios (OR), odds ratio; P-value
Summary
Patients treated with immunotherapy in the real-world may have significantly different responses to those meeting inclusion criteria for random controlled clinical studies. There is a partial overlap in approved indications for the use of the different immune checkpoint inhibitors (ICIs) currently available. In the real-world, patients given immunotherapy may have significantly different treatment criteria from those enrolled in clinical trials [5]. Based on Keynote 407 and Keynote 189 studies, pembrolizumab was approved for the treatment of NSCLC as combination chemotherapy [6, 7]. Studies based on real-world data (RWD) provide a reference for understanding patient outcomes outside of clinical trials and better guide treatment decisions [11]. Most of the current clinical studies used patients on conventional chemotherapy as the controls, but this resulted in a paucity of data with regard to direct efficacy comparisons between the different ICIs administered. An RWD-based cross-sectional study will help to compare the efficacy and safety of different ICIs
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