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. 2023 Mar 21;12(6):2409.
doi: 10.3390/jcm12062409.

Nivolumab or Atezolizumab in the Second-Line Treatment of Advanced Non-Small Cell Lung Cancer? A Prognostic Index Based on Data from Daily Practice

Magdalena Knetki-Wróblewska  1 , Sylwia Tabor  1 , Aleksandra Piórek  1 , Adam Płużański  1 , Kinga Winiarczyk  1 , Magdalena Zaborowska-Szmit  1 , Katarzyna Zajda  1 , Dariusz M Kowalski  1 , Maciej Krzakowski  1
Affiliations

Nivolumab or Atezolizumab in the Second-Line Treatment of Advanced Non-Small Cell Lung Cancer? A Prognostic Index Based on Data from Daily Practice

Magdalena Knetki-Wróblewska et al. J Clin Med. .

Abstract

Background: The efficacy of nivolumab and atezolizumab in advanced pre-treated NSCLC was documented in prospective trials. We aim to confirm the benefits and indicate predictive factors for immunotherapy in daily practice.

Methods: This study was a retrospective analysis. The median PFS and OS were estimated using the Kaplan-Meier method. The log-rank test was used for comparisons. Multivariate analyses were performed using the Cox regression method.

Results: A total of 260 patients (ECOG 0-1) with advanced NSCLC (CS III-IV) were eligible to receive nivolumab or atezolizumab as second-line treatment. Median PFS and OS were three months (95% confidence interval [CI] 2.57-3.42) and 10 months (95% CI 8.03-11.96), respectively, for the overall population. The median OS for the atezolizumab arm was eight months (95% CI 5.89-10.1), while for the nivolumab group, it was 14 months (95% CI 10.02-17.97) (p = 0.018). The sum of all measurable changes >100.5 mm (p = 0.007; HR = 1.003, 95% CI 1.001-1.005), PLT > 281.5 G/l (p < 0.001; HR = 1.003, 95% CI 1.001-1.003) and bone metastases (p < 0.004; HR = 1.58, 95% CI 1.04-2.38) were independent negative prognostic factors for OS in multivariate analysis. Based on preliminary analyses, a prognostic index was constructed to obtain three prognostic groups. Median OS in the subgroups was 16 months (95% CI 13.3-18.7), seven months (95% CI 4.83-9.17) and four months (95% CI 2.88-5.13), respectively (p < 0.001).

Conclusions: Nivolumab and atezolizumab provided clinical benefit in real life. Clinical and laboratory factors may help to identify subgroups likely to benefit. The use of prognostic indices may be valuable in clinical practice.

Keywords: NSCLC; atezolizumab; immunotherapy; nivolumab; prognostic index.

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Conflict of interest statement

M.K.-W. Travel expenses and lectures—BMS, MSD, Roche, AstraZeneca, and Takeda; K.W- Lectures—BMS, Roche, and MSD; S.T.- Lectures—BMS, Roche, and MSD, A.P.- Lectures—BMS, Roche, and MSD, K.Z.—Lectures—BMS, Roche, and MSD, M.Z-S. Lectures—BMS, Roche, and MSD; A.P. Travel Expenses and Lectures—BMS, MSD, Roche, and Takeda; D.M.K. Travel Expenses and Advisory Boards—BMS, Roche, AstraZeneca, Amgen, Takeda, and MSD; M.K. Travel Expenses and Advisory Boards—BMS, Roche, AstraZeneca, and Amgen.

Figures

Figure 1
Figure 1
Probability of survival in the entire population (A) PFS (progression free survival), (B) OS (overall survival).
Figure 2
Figure 2
Overall survival among all patients in correlation to clinical factors: (A)—tumour diameter, (B)—time of response to chemotherapy, (C)—bone metastases, and (D)—liver metastases.
Figure 3
Figure 3
Probability of survival in the prognostic groups.
See this image and copyright information in PMC

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