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Pembrolizumab as First-Line Palliative Therapy in PD-L1 Overexpressing (≥ 50%) NSCLC: Real-world Results with Special Focus on PS ≥ 2, Brain Metastases, and Steroids

Authors :
Christian Grohé
Nikolaj Frost
Norbert Suttorp
Daniel Misch
Burkhard Matthes
Maximilian von Laffert
Elisabeth Olive
Dennis Pultermann
Christian Grah
Jens Kollmeier
Martin Witzenrath
Claudia Vollbrecht
Sebastian Ochsenreither
Matthias Raspe
Source :
Clinical Lung Cancer. 22:411-422
Publication Year :
2021
Publisher :
Elsevier BV, 2021.

Abstract

Introduction Pembrolizumab is a highly effective standard of care in PD-L1 overexpressing (≥ 50%) non–small-cell lung cancer. However, a substantial share of patients from everyday clinical practice is treated without clear evidence from clinical trials. Patients and Methods We performed a retrospective multicentric study including all consecutive patients from 6 certified lung cancer centers in Berlin, Germany, having received pembrolizumab as first-line palliative therapy from January 1 until December 31, 2017. Aims were to validate published clinical trials with a special focus on efficacy and outcome in patients with reduced performance status (PS), brain metastases, and steroids. Results A total of 153 patients were included (median age 69 years, 58% men, 69% adenocarcinoma). Rates for PS ≥ 2, brain metastases, and steroids were 24.8%, 20.9%, and 24.2%, respectively. Median objective response rate, progression-free and overall survival were 48.5%, 8.2 and 22.0 months for all patients and 52.4%, 8.8 and 29.2 months in patients fulfilling the inclusion criteria for the KEYNOTE-024 trial. Patients with a comorbidity-defined PS ≥ 2, symptomatic brain metastases requiring upfront radiotherapy, or baseline steroids had significantly reduced survival. In contrast, durable responses occurred with a tumor-related PS ≥ 2 or asymptomatic brain metastases. Grade 3/4 and 5 immune-related adverse events affected 13.7% and 2.0% of patients. Conclusion Real-world and clinical trial efficacy with upfront pembrolizumab correspond well. Pembrolizumab may sufficiently control asymptomatic brain metastases and may improve a cancer-related reduced PS. However, the frail share of patients with a comorbidity-defined PS ≥ 2, symptomatic brain metastases, or baseline steroids derives no relevant benefit.

Details

ISSN :
15257304
Volume :
22
Database :
OpenAIRE
Journal :
Clinical Lung Cancer
Accession number :
edsair.doi.dedup.....d571aa411560ded4c97ce20d5fe6031c
Full Text :
https://doi.org/10.1016/j.cllc.2021.02.001