Zie ook literatuurlijst niet-toxische stoffen en middelen van arts-bioloog drs. Engelbert Valstar specifiek bij longkanker.

22 maart 2022: Bron: Annals of oncology

Immuuntherapie gegeven als eerstelijns behandeling in de klinische praktijk met alleen een anti-PD medicijn bij patiënten met uitgezaaide niet-kleincellige longkanker  geeft zelfde resultaten op overall overleving of zelfs nog iets beter dan wanneer de immuuntherapie wordt gecombineerd met een op platina gebaseerde chemotherapie. De patiënten die gevolgd werden in een prospectieve studie van patiënten in de klnische praktijk hadden wel een PD-L1 expressie van 50 of meer. 

Figure thumbnail gr2

Kernpunten uit de studie:

  • Longkankerpatiënten met hoge PD-L1 expressie en uitzaaiingen behandeld met alleen immuuntherapie vs immuuntherapie plus chemo hadden een hogere leeftijd en een hogere frequentie van terugkerende ziekte
  • Er werd geen verschil gevonden in mediane overall overleving (OS) tussen longkankerpatiënten met hoge PD-L1 expressie behandeld met alleen immuuntherapie met anti-PD medicijnen in vergelijking met immuuntherapie met anti-PD medicijnen plus chemotherapie.
  • Er bleek ook in de klinische praktijk geen verschil in mediane progressievrije ziektetijd tussen longkankerpatiënten met hoge PD-L1 expressie behandeld met alleen immuuntherapie in vergelijking met immuuntherapie plus chemo.
  • In een verkennende analyse werd wel een betere mediane overall overleving (OS) gevonden en een betere progressievrije ziektetijd voor een kleine niet-rokerssubgroep die werd behandeld met immuuntherapie plus chemo. 
Het volledige studierapport is gepresenteerd op ESMO 2022 en gratis in te zien bij Annals of Oncology. Klik daarvoor op de titel van het abstract:

Effectiveness of PD-(L)1 Inhibitors Alone or in Combination With Platinum-Doublet Chemotherapy in First-Line (1L) Non-Squamous Non-Small Cell Lung Cancer (nsq-NSCLC) With PD-L1–High Expression Using Real-World Data

Published:February 23, 2022DOI:https://doi.org/10.1016/j.annonc.2022.02.008


Highlights:

  • PD-L1−high Nsq-NSCLC patients treated with CIT-mono vs CIT-chemo had older age and higher frequency of recurrent disease
  • No difference was found in median OS between PD-L1−high Nsq-NSCLC patients treated with CIT-mono as compared to CIT-chemo
  • No difference in median real-world PFS between PD-L1−high Nsq-NSCLC patients treated with CIT-mono as compared to CIT-chemo
  • In exploratory analysis, superior OS and real-world PFS was found for the small never-smoker subgroup treated with CIT-chemo

Abstract

Background

Anti−PD-(L)1 therapy alone (cancer immunotherapy -mono) or combined with platinum-based chemotherapy (CIT-chemo) is used as first-line treatment for patients with metastatic non-small cell lung cancer (NSCLC). Our study compared clinical outcomes with CIT-mono vs CIT-chemo in the specific clinical scenario of non-squamous (Nsq)-NSCLC with a high PD-L1 expression of ≥50% (tumor proportion score (TPS) or tumor cells (TC)).

Methods

This was a retrospective cohort study using a real-world de-identified database. Patients with metastatic Nsq-NSCLC with high PD-L1 expression initiating first-line CIT-mono or CIT-chemo between 24 October 2016 and 28 February 2019 were followed up to 28 February 2020. We compared overall survival (OS) and real-world progression-free survival (rwPFS) using Kaplan-Meier methodology. Hazard ratios (HR) were adjusted (aHR) for differences in baseline key prognostic characteristics using inverse probability of treatment weighting methodology.

Results

Patients with PD-L1−high Nsq-NSCLC treated with CIT-mono (n=351), were older and less often presented with de novo stage IV disease than patients treated with CIT-chemo (n=169). With a median follow-up of 19.9 months for CIT-chemo vs 23.5 months for CIT-mono, median OS and rwPFS did not differ between the two groups (median OS: CIT-chemo, 21.0 months vs CIT-mono, 22.1 months, aHR=1.03, 95% CI 0.77-1.39, P=0.83; median rwPFS: CIT-chemo, 10.8 months vs CIT-mono, 11.5 months, aHR=1.04, 95% CI 0.78-1.37, P=0.81). CIT-chemo showed significant and meaningful improvement in OS and rwPFS vs CIT-mono only in the never-smoker subgroup, albeit among a small sample of patients (n=50; OS HR=0.25, 95% CI 0.07-0.83, interaction P=0.02; rwPFS HR=0.40, 95% CI 0.17-0.95, interaction P=0.04).

Conclusion

Except in the subgroup of never-smoker patients, sparing the chemotherapy in first-line CIT treatment does not appear to impact survival outcomes in Nsq-NSCLC patients with high PD-L1 expression.

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Figures

  • Figure thumbnail gr1
    Figure 1Patient Attrition Diagram. Notes: a CIT-chemo included platinum-doublet therapy without bevacizumab; patients participating in a clinical trial were excluded. b ANC ≥1,500 /mcL, Platelets ≥100,000 / mcL, Hemoglobin ≥9 g/dL, Serum creatinine ≤1.5xULN, Total bilirubin ≤1.5xULN, AST and ALT ≤2.5xULN. c a recording of vital information, a medication administration, a non-cancelled drug order, or a laboratory test/result being reported. d To limit the intensive abstraction process, Flatiron delivered de-identified data for a random sample of metastatic patients (limit set around 1000 pts before project start).
  • Figure thumbnail gr2
    Figure 2Overall Survival. A) Kaplan-Meier plot for Overall Survival, by treatment group. B) Exploration of treatment effect within levels of clinicopathological variables of interest. C) Kaplan-Meier plot for Overall Survival, by treatment group and smoking status.
  • Figure thumbnail gr3
    Figure 3rw-Progression-Free Survival. A) Kaplan-Meier plot for rw-Progression-Free Survival, by treatment group. Note1. 16 patients of the 520 in total were excluded from the rwPFS analysis due to missing information for the date of last clinical note. Note2: Proportional hazards assumption was violated in the unadjusted Cox model (Schoenfeld residual test), while it was satisfied in the adjusted model. B) Exploration of treatment effect within levels of clinicopathological variables of interest. C) Kaplan-Meier plot for rw-Progression-Free Survival, by treatment group and smoking status.

Tables


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