Real-World Clinical Impact of Immune Checkpoint Inhibitors in Patients With Advanced/Metastatic Non–Small Cell Lung Cancer After Platinum Chemotherapy

• Published in: Clinical lung cancer 2019-07, Vol.20 (4), p.287-296.e4
• Main Authors: Schwartzberg, Lee, Korytowsky, Beata, Penrod, John R., Zhang, Ying, Le, T. Kim, Batenchuk, Cory, Krug, Lee
• Format: Article
• Language: English
• Subjects: Aged; Anaplastic Lymphoma Kinase - genetics; Antineoplastic Agents, Immunological - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; B7-H1 Antigen - antagonists & inhibitors; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - genetics; Carcinoma, Non-Small-Cell Lung - mortality; Cohort Studies; Drug Utilization; ErbB Receptors - genetics; Female; Follow-Up Studies; Humans; Immunotherapy; Lung Neoplasms - drug therapy; Lung Neoplasms - genetics; Lung Neoplasms - mortality; Male; Mutation - genetics; Neoplasm Metastasis; Neoplasm Staging; NSCLC; Observational; Platinum Compounds - therapeutic use; Retrospective Studies; Second-line; Survival Analysis; Utilization patterns
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2019.04.004

The real-world effect of anti-programmed death ligand 1 (PD-L1) therapies is unclear. We compared US patients who received second-line therapy for non–small-cell lung cancer (NSCLC) before and shortly after US Food and Drug Administration (FDA) approval of PD-L1 inhibitors. Patients in the Flatiron Health database (≥18 years; received first-line platinum therapy for advanced/metastatic NSCLC; ≥6 months of follow-up) were assessed before (“historical”: January 1, 2011 to December 31, 2013) and after (“current”: January 1, 2015 to May 31, 2017) FDA approval of anti–PD-L1 therapies for NSCLC. Index was start of second-line therapy. Baseline variables, treatment patterns, and overall survival (OS) were reported. A greater proportion of patients in the current cohort received second-line treatment than in the historical cohort (n = 4240 [57.0%] vs. n = 2357 [37.4%]); 48.8% [n = 2071] of the current second-line patients received anti–PD-L1 therapy. Current patients were more likely to receive second-line anti–PD-L1 therapy if they had poorer Eastern Cooperative Oncology Group (ECOG) performance status (≥2), had squamous histology, or had no epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), or ROS proto-oncogene 1 mutations. Median OS from index was higher in the current cohort (9.4 [95% confidence interval (CI), 8.9-9.9] months) than the historical cohort (7.3 [95% CI, 6.9-7.8] months). Adjusted for sex, race, ECOG performance status, disease stage, and Kirsten rat sarcoma viral oncogene homolog, EGFR, and ALK status, OS was improved by 15% in the current cohort. Contemporary patients are more likely to receive second-line therapy and have longer OS than patients who received care before approval of anti–PD-L1 therapies. We compared real-world data from US patients who received second-line (2L) therapy for non–small-cell lung cancer before (“historical”) and after (“current”) US Food and Drug Administration approval of programmed death ligand 1 (PD-L1) inhibitors. A greater proportion of patients received 2L therapy in the current compared with the historical setting; approximately half of current patients received 2L PD-L1 inhibitors. Survival was improved by 15% in the current setting.