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Multicenter Study
. 2023 Jan;72(1):91-99.
doi: 10.1007/s00262-022-03232-2. Epub 2022 Jun 21.

First-line single-agent pembrolizumab for PD-L1-positive (tumor proportion score ≥ 50%) advanced non-small cell lung cancer in the real world: impact in brain metastasis: a national French multicentric cohort (ESCKEYP GFPC study)

Renaud Descourt  1 , Laurent Greillier  2 , Maurice Perol  3 , Charles Ricordel  4 , Jean-Bernard Auliac  5 , Lionel Falchero  6 , Radj Gervais  7 , Rémi Veillon  8 , Sabine Vieillot  9 , Florian Guisier  10 , Marie Marcq  11 , Grégoire Justeau  12 , Laurence Bigay-Game  13 , Marie Bernardi  14 , Pierre Fournel  15 , Hélène Doubre  16 , Julian Pinsolle  17 , Karim Amrane  18 , Christos Chouaïd  19 , Chantal Decroisette  20
Affiliations
Multicenter Study

First-line single-agent pembrolizumab for PD-L1-positive (tumor proportion score ≥ 50%) advanced non-small cell lung cancer in the real world: impact in brain metastasis: a national French multicentric cohort (ESCKEYP GFPC study)

Renaud Descourt et al. Cancer Immunol Immunother. 2023 Jan.

Abstract

Background: Few real-world data are available in patients with advanced metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy, particularly in those with brain metastases at treatment initiation.

Methods: This was a national, retrospective, multicenter study that consecutively included all patients with PD-L1-positive (tumor proportion score ≥ 50%) advanced NSCLC who initiated first-line treatment with pembrolizumab as a single agent between May 2017 (date of availability of pembrolizumab in this indication in France) to November 22, 2019 (approval of the pembrolizumab-chemotherapy combination). Data were collected from medical records with local response assessment.

Results: The cohort included 845 patients and 176 (20.8%) had brain metastases at diagnosis. There were no significant differences in outcomes for patients with and without brain metastases: 9.2 (95% CI 5.6-15) and 8 (95% CI 6.7-9.2, p = 0.3) months for median progression-free survival (PFS) and, 29.5 (95% CI 17.2-NA) and 22 (95% CI 17.8-27.1, p = 0.3) months for median overall survival (OS), respectively. Overall response rates were 47% and 45% in patients with and without cerebral metastases. In multivariate analysis, performance status 2-4 vs. 0-1 and neutrophil-to-lymphocyte ratio ≥ 4 vs. < 4 were the main independent negative factors for OS; brain metastasis was not an independent factor for OS.

Conclusion: In this large multicenter cohort, nearly 20% of patients initiating pembrolizumab therapy for advanced NSCLC had cerebral metastases. There was no significant difference in response rates, PFS and OS between patients with and without brain metastases.

Keywords: Advanced stage; Brain metastases; Non-small cell lung cancer; Pembrolizumab; Real-world study.

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Conflict of interest statement

L. Greillier reports grants, personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, Roche, Sanofi Aventis, Bristol-Myers Squibb, Merck Sharp & Dohme, Lilly, Novartis, Pfizer, Takeda, Bayer and Amgen, outside the submitted work. C. Chouaid reports grants, personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, GSK, Roche, Sanofi Aventis, Bristol-Myers Squibb, Merck Sharp & Dohme, Lilly, Novartis, Pfizer, Takeda, Bayer and Amgen, outside the submitted work. C. Decroisette reports personal fees and non-financial support from AstraZeneca, Boehringer Ingelheim, Roche, Sanofi Aventis, Bristol-Myers Squibb, Merck Sharp & Dohme, Lilly, Novartis, Pfizer, Takeda, and Amgen, outside the submitted work. M. Pérol reports personal fees and non-financial support from Roche, Eli Lilly, Pfizer, Boehringer Ingelheim, Merck Sharp & Dohme, Bristol-Myers Squibb, Novartis, AstraZeneca, Takeda, Gritstone, Sanofi, GlaxoSmithKline, Amgen, Chugai, Illumina, Daïchi-Sankyo and Abbvie outside the submitted work. R. Descourt reports personal fees and non-financial support from AstraZeneca, Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Takeda, and Chugai, outside the submitted work. C. Ricordel, J.B. Auliac, L. Falchero, R. Gervais, R. Veillon, S. Vieillot, F. Guisier, M. Marcq, G. Justeau, L. Bigay-Game, M. Bernardi, P. Fournel, H. Doubre, J. Pinsolle and K. Amrane report no conflict of interest.

Figures

Fig. 1
Fig. 1
Progression-free survival (PFS) (95% confidence interval in light blue on the survival curve)
Fig. 2
Fig. 2
Overall survival (OS) (95% confidence interval in light blue on the survival curve)
See this image and copyright information in PMC

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