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Pembrolizumab for advanced non-small cell lung cancer (NSCLC): Impact of autoimmune comorbidity and outcomes following treatment completion.
- Source :
- Journal of Oncology Pharmacy Practice; Jun2023, Vol. 29 Issue 4, p785-793, 9p
- Publication Year :
- 2023
-
Abstract
- Introduction: Pembrolizumab, an immune-checkpoint inhibitor, is approved for first-line treatment of metastatic NSCLC in patients with tumours expressing programmed death-ligand 1 (PD-L1) with tumour proportion score (TPS) of ≥50%. We aimed to clarify some uncertainties regarding use of immunotherapy in patients with previous autoimmune (AI) disorders and assess real-world outcomes following treatment completion. Methods: We performed a retrospective case record review of 82 patients with tumours expressing PD-L1 at TPS ≥ 50% and receiving first-line Pembrolizumab. Survival was estimated using the Kaplan Meier method. Results: After 36.93 months (IQR: 34.37–40.20) median follow-up, median OS was 13.6 months (95% CI 8.9–19.3). There were 10 patients (12%) with AI co-morbidities and there was a trend toward improved median OS for this group versus those without AI comorbidity, 42 months (14.87-NR) versus 10.7 months (7.3–17.8), p = 0.073. Sixteen patients (20%) with nonprogressive disease at 2 years had significantly better median OS compared to those who did not complete 2 years of treatment, NR (42- NR) and 8.7 (5.8–14.1), p < 0.001. Immune related adverse events (irAE) of any grade occurred in 90% of the AI cohort compared with 70.8% of patients without AI comorbidity. Low grade adrenal insufficiency was the only irAE which occurred at a significantly higher rate in the AI group, p = 0.02. Conclusion: Patients with previous AI diseases tolerate treatment well, and there is a non-significant trend for improved outcomes in this group. Patients who complete the course of pembrolizumab have significantly better survival outcomes than those who do not. [ABSTRACT FROM AUTHOR]
- Subjects :
- AUTOIMMUNE disease treatment
THERAPEUTIC use of antineoplastic agents
LUNG cancer
IMMUNE checkpoint inhibitors
CONFIDENCE intervals
PROGRAMMED death-ligand 1
UNCERTAINTY
METASTASIS
RETROSPECTIVE studies
ADRENAL insufficiency
TREATMENT effectiveness
COMPARATIVE studies
KAPLAN-Meier estimator
DESCRIPTIVE statistics
SURVIVAL analysis (Biometry)
PATIENT compliance
IMMUNOTHERAPY
COMORBIDITY
Subjects
Details
- Language :
- English
- ISSN :
- 10781552
- Volume :
- 29
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- Journal of Oncology Pharmacy Practice
- Publication Type :
- Academic Journal
- Accession number :
- 164375285
- Full Text :
- https://doi.org/10.1177/10781552221079356