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Low Risk of Hyperprogression with First-Line Chemoimmunotherapy for Advanced Non-Small Cell Lung Cancer: Pooled Analysis of 7 Clinical Trials.
- Source :
- Oncologist; Apr2023, Vol. 28 Issue 4, pe205-e211, 7p, 1 Diagram, 2 Charts
- Publication Year :
- 2023
-
Abstract
- Background Monotherapy immune checkpoint inhibitor (ICI) used in second- or later-line settings has been reported to induce hyperprogression. This study evaluated hyperprogression risk with ICI (atezolizumab) in the first-, second-, or later-line treatment of advanced non–small cell lung cancer (NSCLC), and provides insights into hyperprogression risk with contemporary first-line ICI treatment. Methods Hyperprogression was identified using Response Evaluation Criteria in Solid Tumours (RECIST)-based criteria in a dataset of pooled individual-participant level data from BIRCH, FIR, IMpower130, IMpower131, IMpower150, OAK, and POPLAR trials. Odds ratios were computed to compare hyperprogression risks between groups. Landmark Cox proportional-hazard regression was used to evaluate the association between hyperprogression and progression-free survival/overall survival. Secondarily, putative risk factors for hyperprogression among second- or later-line atezolizumab-treated patients were evaluated using univariate logistic regression models. Results Of the included 4644 patients, 119 of the atezolizumab-treated patients (n = 3129) experienced hyperprogression. Hyperprogression risk was markedly lower with first-line atezolizumab—either chemoimmunotherapy or monotherapy—compared to second/later-line atezolizumab monotherapy (0.7% vs. 8.8%, OR = 0.07, 95% CI, 0.04-0.13). Further, there was no statistically significant difference in hyperprogression risk with first-line atezolizumab-chemoimmunotherapy versus chemotherapy alone (0.6% vs. 1.0%, OR = 0.55, 95% CI, 0.22-1.36). Sensitivity analyses using an extended RECIST-based criteria including early death supported these findings. Hyperprogression was associated with worsened overall survival (HR = 3.4, 95% CI, 2.7-4.2, P <.001); elevated neutrophil-to-lymphocyte ratio was the strongest risk factor for hyperprogression (C -statistic = 0.62, P <.001). Conclusions This study presents first evidence for a markedly lower hyperprogression risk in advanced NSCLC patients treated with first-line ICI, particularly with chemoimmunotherapy, as compared to second- or later-line ICI treatment. [ABSTRACT FROM AUTHOR]
- Subjects :
- THERAPEUTIC use of monoclonal antibodies
DISEASE progression
LUNG cancer
DRUG efficacy
STATISTICS
IMMUNE checkpoint inhibitors
CONFIDENCE intervals
CANCER chemotherapy
RISK assessment
CANCER patients
COMPARATIVE studies
NEUTROPHIL lymphocyte ratio
DESCRIPTIVE statistics
RESEARCH funding
DATA analysis
DATA analysis software
ODDS ratio
PROGRESSION-free survival
LOGISTIC regression analysis
TUMOR markers
IMMUNOTHERAPY
SECONDARY analysis
PROPORTIONAL hazards models
OVERALL survival
EVALUATION
Subjects
Details
- Language :
- English
- ISSN :
- 10837159
- Volume :
- 28
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- Oncologist
- Publication Type :
- Academic Journal
- Accession number :
- 163613107
- Full Text :
- https://doi.org/10.1093/oncolo/oyad043