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Multicenter Study
. 2019 Oct 1;30(10):1653-1659.
doi: 10.1093/annonc/mdz288.

Outcomes to first-line pembrolizumab in patients with non-small-cell lung cancer and very high PD-L1 expression

E J Aguilar  1 , B Ricciuti  1 , J F Gainor  2 , K L Kehl  1 , S Kravets  3 , S Dahlberg  3 , M Nishino  4 , L M Sholl  5 , A Adeni  1 , S Subegdjo  1 , S Khosrowjerdi  2 , R M Peterson  2 , S Digumarthy  2 , C Liu  6 , J Sauter  7 , H Rizvi  8 , K C Arbour  8 , B W Carter  9 , J V Heymach  10 , M Altan  10 , M D Hellmann  11 , M M Awad  12
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Free article
Multicenter Study

Outcomes to first-line pembrolizumab in patients with non-small-cell lung cancer and very high PD-L1 expression

E J Aguilar et al. Ann Oncol. .
Free article

Abstract

Background: In non-small-cell lung cancers with programmed death-ligand 1 (PD-L1) expression on ≥50% of tumor cells, first-line treatment with the PD-1 inhibitor pembrolizumab improves survival compared with platinum-doublet chemotherapy. Whether higher PD-L1 levels within the expression range of 50%-100% predict for even greater benefit to pembrolizumab is currently unknown.

Patients and methods: In this multicenter retrospective analysis, we analyzed the impact of PD-L1 expression levels on the overall response rate (ORR), median progression-free survival (mPFS), and median overall survival (mOS) in patients who received commercial pembrolizumab as first-line treatment of non-small-cell lung cancer (NSCLC) with a PD-L1 expression of ≥50% and negative for genomic alterations in the EGFR and ALK genes .

Results: Among 187 patients included in this analysis, the ORR was 44.4% [95% confidence interval (CI) 37.1% to 51.8%], the mPFS was 6.5 months (95% CI 4.5-8.5), and the mOS was not reached. The median PD-L1 expression level among patients who experienced a response to pembrolizumab was significantly higher than among patients with stable or progressive disease (90% versus 75%, P < 0.001). Compared with patients with PD-L1 expression of 50%-89% (N = 107), patients with an expression level of 90%-100% (N = 80) had a significantly higher ORR (60.0% versus 32.7%, P < 0.001), a significantly longer mPFS [14.5 versus 4.1 months, hazard ratio (HR) 0.50 (95% CI 0.33-0.74), P < 0.01], and a significantly longer mOS [not reached versus 15.9 months, HR 0.39 (95% CI 0.21-0.70), P = 0.002].

Conclusion: Among patients with NSCLC and PD-L1 expression of ≥50% treated with first-line pembrolizumab, clinical outcomes are significantly improved in NSCLCs with a PD-L1 expression of ≥90%. These findings have implications for treatment selection as well as for clinical trial interpretation and design.

Keywords: NSCLC; PD-L1; pembrolizumab.

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