51. Clinicopathologic correlates of pembrolizumab efficacy in patients with advanced NSCLC and a PD-L1 expression of ≥ 50%
- Author
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Alfredo Addeo, Vincenzo Di Noia, Robert A. Belderbos, Francesco Grossi, Joachim G.J.V. Aerts, Giampiero Porzio, Simona Scodes, Raffaele Giusti, Federico Cappuzzo, Giorgia Guaitoli, Diego Signorelli, Lorenzo Antonuzzo, Corrado Ficorella, Alessio Cortellini, Luigi Della Gravara, Alex Friedlaender, Giovanni Mansueto, Sebastiano Buti, Marcello Tiseo, Emilio Bria, Paolo Marchetti, Simona Carnio, Domenico Galetta, Alain Gelibter, Giada Targato, Ornella Cantale, Lorenza Landi, Diego Cortinovis, Maria Giovanna Dal Bello, Alessandro De Toma, Olga Nigro, Russano Marco, Luca Sala, Cinzia Baldessari, Michele De Tursi, Paola Bordi, Mariangela Torniai, Miriam Grazia Ferrara, Vincenzo Sforza, Marco Filetti, Maria Rita Migliorino, Claudia Proto, Giuseppe Luigi Banna, Alessandro Tuzi, Giulio Metro, Daniele Santini, Ettore D'Argento, Erika Rijavec, Stefania Gori, Biagio Ricciuti, Serena Ricciardi, Annamaria Catino, Rossana Berardi, Federica Zoratto, Marianna Macerelli, Paolo Bironzo, Luca Cantini, Fausto Barbieri, Francesca Mazzoni, Rita Chiari, Francesca Rastelli, Alessio Grieco, Alessandro Morabito, Fabrizio Citarella, Matteo Santoni, Carlo Genova, Danilo Rocco, Francesco Passiglia, Marianna Tudini, and Pamela Pizzutilo
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,First line ,Pembrolizumab ,medicine.disease ,Metastasis ,Clinical trial ,Multicenter study ,Internal medicine ,Tobacco exposure ,medicine ,In patient ,Pd l1 expression ,business - Abstract
BackgroundSingle agent pembrolizumab represents the standard first line option for metastatic non-small-cell-lung-cancer (NSCLC) patients with a PD-L1 (programmed death-ligand 1) expression of ≥ 50%.MethodsWe conducted a multicenter study aimed at evaluating the clinicopathologic correlates of pembrolizumab efficacy in patients with treatment-naïve NSCLC and a PD-L1 TPS ≥ 50%.Results1026 consecutive patients were included. ECOG-PS ≥ 2 (p < 0.0001) and bone metastases (p = 0.0003) were confirmed to be independent predictors of a worse ORR. Former smokers (p = 0.0002), but not current smokers (p = 0.0532) were confirmed to have a significantly prolonged PFS compared to never smokers at multivariate analysis. ECOG-PS (p < 0.0001), bone metastases (p < 0.0001) and liver metastases (p < 0.0001) were also confirmed to be independent predictors of a worse PFS. Previous palliative RT was significantly related to a shortened OS (p = 0.0104), while previous non-palliative RT was significantly related to a prolonged OS (p = 0.0033). Former smokers (p = 0.0131), but not current smokers (p = 0.3433) were confirmed to have a significantly prolonged OS compared to never smokers. ECOG-PS (p < 0.0001), bone metastases (p < 0.0001) and liver metastases (p < 0.0001) were also confirmed to be independent predictors of a shortened OS. A PD-L1 expression of ≥ 90%, as assessed by recursive partitioning, was associated with significantly higher ORR (p = 0.0204), and longer and OS (p = 0.0346) at multivariable analysis.Conclusionspembrolizumab was effective in a large cohort of NSCLC patients treated outside of clinical trials. We confirmed that the absence of tobacco exposure, and the presence of bone and liver metastasis are associated with worse clinical outcomes to pembrolizumab. Increasing levels of PD-L1 expression may help identifying a subset of patients who derive a greater benefit from pembrolizumab monotherapy.
- Published
- 2020