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Multicenter Study
. 2020 Dec:150:123-131.
doi: 10.1016/j.lungcan.2020.10.008. Epub 2020 Oct 22.

Chemotherapy in non-small cell lung cancer patients after prior immunotherapy: The multicenter retrospective CLARITY study

Melissa Bersanelli  1 , Sebastiano Buti  2 , Diana Giannarelli  3 , Alessandro Leonetti  4 , Alessio Cortellini  5 , Giuseppe Lo Russo  6 , Diego Signorelli  6 , Luca Toschi  7 , Michele Milella  8 , Sara Pilotto  8 , Emilio Bria  9 , Claudia Proto  6 , Arianna Marinello  7 , Giovanni Randon  6 , Sabrina Rossi  7 , Emanuele Vita  9 , Giulia Sartori  8 , Ettore D'Argento  9 , Eva Qako  10 , Elisa Giaiacopi  10 , Laura Ghilardi  11 , Anna Cecilia Bettini  11 , Elena Rapacchi  2 , Francesca Mazzoni  12 , Daniele Lavacchi  12 , Vieri Scotti  13 , Lucia Pia Ciccone  13 , Michele De Tursi  14 , Pietro Di Marino  14 , Daniele Santini  15 , Marco Russano  15 , Paola Bordi  2 , Massimo Di Maio  16 , Marco Audisio  16 , Marco Filetti  17 , Raffaele Giusti  17 , Rossana Berardi  18 , Ilaria Fiordoliva  18 , Giulio Cerea  19 , Elio Gregory Pizzutilo  19 , Alessandra Bearz  20 , Elisa De Carlo  20 , Fabiana Cecere  21 , Davide Renna  21 , Roberta Camisa  2 , Giuseppe Caruso  2 , Corrado Ficorella  5 , Giuseppe Luigi Banna  22 , Diego Cortinovis  23 , Matteo Brighenti  24 , Marina Chiara Garassino  6 , Marcello Tiseo  4
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Free article
Multicenter Study

Chemotherapy in non-small cell lung cancer patients after prior immunotherapy: The multicenter retrospective CLARITY study

Melissa Bersanelli et al. Lung Cancer. 2020 Dec.
Free article

Abstract

Objectives: In the most of cases, for non-small cell lung cancer (NSCLC) patients who progressed to previous immune checkpoint inhibitors (CKI) administered as first- or as second-line therapy, chemotherapy (CT) remains the only viable options in the absence of "druggable" mutations. We aimed to explore the efficacy of salvage chemotherapy after immunotherapy (SCAI) in advanced NSCLC patients.

Materials and methods: We designed a retrospective, multicenter study, involving 20 Italian centers, with the primary objective of describing the clinical outcome of advanced NSCLC patients treated with SCAI at the participating institutions from November 2013 to July 2019. The primary endpoint of the study was represented by overall survival (OS), defined as the time from CT initiation to death. Secondary outcome endpoints of the SCAI (progression free survival, PFS, objective response rate, ORR and toxicity) and explorative biomarkers (lactate dehydrogenase, LDH, and neutrophil-to-lymphocyte ratio, NLR during immunotherapy) were also analyzed.

Results: In our study population of 342 NSCLC patients, SCAI obtained a median OS of 6.8 months (95 % confidence interval, CI 5.5-8.1), median PFS of 4.1 months (95 % CI 3.4-4.8) and ORR of 22.8 %. A "Post-CKI score" was constructed by combining significant predictors of OS at the multivariate analyses (sex, ECOG PS, disease control with prior immunotherapy), Harrell'C was 0.65, (95 % CI:0.59-0.71).

Conclusions: Despite the late-line settings, our findings support the hypothesis that previous immunotherapy might increase the sensitivity of the tumor to the subsequent chemotherapy. The "Post-CKI score" was clinically effective in successfully discriminating three distinct prognostic subgroups of patients after the failure of CKI, representing a possibly useful tool for the tailored decision-making process of advanced treatment-line settings in NSCLC.

Keywords: CLARITY; Chemotherapy after immunotherapy; Immune checkpoint inhibitors; NSCLC; Salvage chemotherapy.

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