Background and importance The guidelines recommend anti-PD-1/PD-L1 immunotherapy as secondline treatment in patients with locally advanced or metastatic non-small cell lung cancer (NSCLC), regardless of PD-L1 expression.
Aim and objectives To evaluate the effectiveness of treatment with checkpoint inhibitors (ICI) (nivolumab, pembrolizumab and atezolizumab) in the secondline treatment of metastatic NSCLC.
Material and methods This was a descriptive, transversal, retrospective research of all patients treated with ICI as a secondline treatment for metastatic NSCLC between November 2013 and September 2019. Variables collected were: age, sex, histology, PD-L1 expression, ECOG at the beginning of treatment, cycles received and duration of treatment. Effectiveness criteria were: median overall survival (OS), and OS at 2 and 3 years (Kaplan–Meier method). Data were obtained from the electronic clinical record and the onco-haematological electronic prescription programme (Oncowin). Analysis was done by SPSS Statistics.
Results A total of 119 patients were included (74.8% men), with a median age at the beginning of treatment of 67 years (48–86). Histology was adenocarcinoma in 59.48%, squamous in 37.07% and large cell in 3.45%. We found that 15.12% of patients had negative PDL-1 (<1%), 24.37% PDL-1 (1–50%) and 17.65% PDL-1 (>50%); in 42.86% of patients, expression was not determined. ECOG at the beginning of treatment was 47.31% for ECOG 0 and 52.69% for ECOG 1. A total of 53.78% of patients were treated with nivolumab, 14.29% with pembrolizumab and 31.93% with atezolizumab, with median number of cycles administered of 6 (1–57). Median OS was 8.89 months (95% CI 6.13–11.65). No significant differences were found in median OS based on expression of PDL-1 or drug. Variable that significantly influenced median OS were ECOG (ECOG 0 greater survival, p=0.045). OS at 2 and 3 years were 24.7% and 17.0%, respectively. In 29.41% of patients, thirdline chemotherapy was given: 57.14% taxane monotherapy, 11.42% pemetrexed, 14.28% carboplatin–pemetrexed and 17.16% other, with a median OS of 7.77 months (95% CI 4.37–11.17).
Conclusion and relevance Under usual clinical practice, ICI achieved an OS of 8.72 months, lower than that obtained in the pivotal trials, but the percentage of long term survivors was similar to the pivotal trials. Although the percentage of patients who were treated with a thirdline was low, their OS was considerable.
References and/or acknowledgements No conflict of interest.