RESULT OF PEMBROLIZUMAB PLUS CHEMOTHERAPY IN THE FIRST-LINE THERAPY FOR DISTANT METASTATIC NON-SMALL-CELL LUNG CANCER WITH PD-L1 ≥1%, EGFR(-), ALK(-) AND ROS1(-)
Main Article Content
Abstract
Objectives: Evaluating the results of chemotherapy with pembrolizumab in the firstline treatment for patients with distant metastatic non-small cell lung cancer with PD-L1≥1%, EGFR(-), ALK(-) and ROS1(-): overall survival, progression-free survival, treatment-related adverse events.
Subjects and methods: Patients with distant metastatic non-small cell lung cancer with PD-L1≥1%, EGFR(-), ALK(-) and ROS1(-) received chemotherapy plus pembrolizumab as first-line treatment from October 2019 to Feb 2023 at Military Hospital 175 with appropriate inclusion and exclusion criteria. Cohort study, retrospective.
Results: The study enrolled 52 patients with the following characteristics: average age 68.9±18.8; 84.6% are male; 53.8% had PS=1 and 46.2% had PS=2; 78.8% are smoker; pathologic evaluation: adenocarcinoma accounted for 78.8%, squamous cell carcinoma accounted for 21.2%; 48.1% expressed PD-L1 at levels 1-49% and 51.9% showed levels ≥50%; 40.4% had brain metastases from the start of the study, there were 03 chemotherapy regimens selected including 02 regimens for adenocarcinoma: cisplatin/pemetrxed accounted for 38.5%, and carboplatin/ pemetrxed regimen accounted for 38.5% and carboplatin/paclitaxel regimen accounted for 23.1% for patients with squamous cell pathology. Patients received chemotherapy with 4/5/6 cycles with rates of 21.2%/42.3%/36.5% respectively; The rate of adherence to pembrolizumab according to the regimen was 91.9%; Grade 3 or worse adverse events include anemia 15.4%, neutropenia 34.6%, thrombocytopenia 3.8% and interstitial lung disease 3.8%.
Outcomes: mean follow-up 24.0 months, median PFS = 15.0 months (95% CI: 11 to 28), median OS = 23.0 months (95% CI: 18 to 28), patients with high PD-L1 expression levels (≥50%) had significantly higher OS and PFS than the group with low PD-L1 (1-49%) with Logranks test with p values respectively are 0.003 and 0.0018.
Conclusions: Pembrolizumab plus chemotherapy in first-line treatment for patients with distant metastatic non-small-cell lung cancer with PD-L1≥1%, EGFR(-), ALK(-) and ROS1(-) has acceptable toxicity, improves both OS and PFS, especially in patients with high PD-L1 expression levels.
Keywords
Non-small-cell lung cancer, pembrolizumab
Article Details
References
Lê Tuấn Anh, Vương Đình Thy Hảo, Nguyễn Ngọc Bảo Hoàng, (2020), Mức độ biểu hiện PD-L1 trong ung thư phổi không tế bào nhỏ giai đoạn di căn , Tạp Chí Ung Thư Học Việt Nam. 5(1), tr.165-170.
Nguyễn Đặng Thuận An (2021), Hiệu quả và tính an toàn của các phác đồ có pembrolizumab trong ung thư phổi không tế bào nhỏ giai đoạn IV, Luận văn thạc sĩ y học ung bướu, ĐH y dược TPHCM.
NCCN guideline (2023) , Non small call lung cancer, version 4.2023 https://www.nccn.org/professionals/ physician_gls/pdf/nscl.pdf (truy cập 11/2023).
Rodríguez-Abreu D, Powell S F, Hochmair M J, Gadgeel S M, et al, (2021), Pemetrexed Plus Platinum With or Without Pembrolizumab in Patients With Previously Untreated Metastatic Nonsquamous NSCLC: Protocol-Specified Fina Analysis From KEYNOTE-189”, Annals of oncology : official journal of the European Society for Medical Oncology, pp.
Paz-Ares, Luis et al, (2020). A Randomized , Placebo-Controlled Trial of Pembrolizumab Plus Chemotherapy in Patients With Metastatic Squamous NSCLC: Protocol-Specified Final Analysis of KEYNOTE-407, Journal of Thoracic Oncology, Volume 15, Issue 10, 1657 – 1669.
Reck M, Rodríguez-Abreu D, Robinson A G, Hui R, et al, (2016), “Pembrolizumab versus Chemotherapy for PD-L1–Positive Non–Small-Cell Lung Cancer”, New England Journal of Medicine, 375 (19), pp. 1823-18