Pembrolizumab monotherapy for advanced/recurrent non-small cell lung cancer: a Greater Manchester experience
Wu, K S
Blackhall, Fiona H
Summers, Yvonne J
AffiliationCecilia Centre, Manchester University NHS Foundation Trust, Manchester,
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AbstractIntroduction: Pembrolizumab monotherapy is first-line (FL) treatment for patients with advanced/recurrent non-small cell lung cancer with PD-L1 ≥50% and second-line (SL) for PD-L1 ≥1%. Here we report on a cohort of 173 patients (76FL, 97 SL) who received pembrolizumab as standard of care across Greater Manchester. Methods: Patients were identified using chemotherapy prescribing software and Blue-teq Cancer Drugs Fund forms. Case-notes and imaging were reviewed to obtain data on demographics, response, toxicities and progression/survival. Analysis was performed using SPSS. Results: Median age was 69 years (70FL, 68SL, range 34-88); 98 were male and 75 female. 156 were former or current smokers. 11 had previous treatment for brain metastases. Best response (according to local radiological reporting/clinical progression) was assessed in 155. 45.2% progressed and 54.8% stabilised or responded. 22 patients continued treatment beyond progression and 8 subsequently derived benefit (stabilised or responded). Median PFS was 6 months in FL and 3 months in SL patients. Median OS had not yet been reached but median OS at 6 months was 69.7% in FL and 73.2% in SL. PFS was significantly different (log-rank p=0.004) between patients with PD-L1 ≥50% (median PFS 6.9 months) and patients with PD-L1 <50% (median PFS 2.6 months). No significant difference in overall survival (p=0.46). 44.6% patients experienced immune related adverse events (IRAE) (55.3% FL, 38.14% SL). 10.4% patients developed grade 3-5 IRAEs, including one death due to pneumonitis. 16.2% received systemic steroids and 9.2% discontinued treatment due to toxicity. There was no significant relationship between age and the presence of any IRAE (p=0.36). Conclusion: Pembrolizumab is well tolerated in real world patients, with lower rates of IRAEs than Keynote 024. PFS and OS appear worse, but FL pembrolizumab data are immature and longer followup is needed. Results support the use of PD-L1 expression as a predictive biomarker of response to pembrolizumab.
CitationTivey A, Wu KS, Tay R, Gomes F, Taylor P, Blackhall F, et al. Pembrolizumab monotherapy for advanced/recurrent non-small cell lung cancer: a Greater Manchester experience. Lung Cancer. 2019;127:S45-S6.
TypeMeetings and Proceedings