Nationwide Survival Benefit after Implementation of First-Line Immunotherapy for Patients with Advanced NSCLC—Real World Efficacy

• Published in: Cancers 2021-09, Vol.13 (19), p.4846
• Main Authors: Mouritzen, Mette T., Carus, Andreas, Ladekarl, Morten, Meldgaard, Peter, Nielsen, Anders W. M., Livbjerg, Anna, Larsen, Jacob W., Skuladottir, Halla, Kristiansen, Charlotte, Wedervang, Kim, Schytte, Tine, Hansen, Karin H., Østby, Anne-Cathrine, Frank, Malene S., Lauritsen, Jakob, Sørensen, Jens B., Langer, Seppo W., Persson, Gitte F., Andersen, Jon L., Frary, Johanna M. C., Drivsholm, Lars B., Vesteghem, Charles, Christensen, Heidi S., Bjørnhart, Birgitte, Pøhl, Mette
• Format: Article
• Language: English
• Subjects: Clinical trials; Electronic health records; Electronic medical records; Epidermal growth factor; Estimates; Histopathology; Immune checkpoint inhibitors; Immunotherapy; Liver; Lung cancer; Medical prognosis; Metastases; Metastasis; Non-small cell lung carcinoma; Patients; Protein-tyrosine kinase; Small cell lung carcinoma
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers13194846

Background The selection of patients with non-small cell lung cancer (NSCLC) for immune checkpoint inhibitor (ICI) treatment remains challenging. This real-world study aimed to compare the overall survival (OS) before and after the implementation of ICIs, to identify OS prognostic factors, and to assess treatment data in first-line (1L) ICI-treated patients without epidermal growth factor receptor mutation or anaplastic lymphoma kinase translocation. Methods Data from the Danish NSCLC population initiated with 1L palliative antineoplastic treatment from 1 January 2013 to 1 October 2018, were extracted from the Danish Lung Cancer Registry (DLCR). Long-term survival and median OS pre- and post-approval of 1L ICI were compared. From electronic health records, additional clinical and treatment data were obtained for ICI-treated patients from 1 March 2017 to 1 October 2018. Results The OS was significantly improved in the DLCR post-approval cohort (n = 2055) compared to the pre-approval cohort (n = 1658). The 3-year OS rates were 18% (95% CI 15.6–20.0) and 6% (95% CI 5.1–7.4), respectively. On multivariable Cox regression, bone (HR = 1.63) and liver metastases (HR = 1.47), performance status (PS) 1 (HR = 1.86), and PS ≥ 2 (HR = 2.19) were significantly associated with poor OS in ICI-treated patients. Conclusion OS significantly improved in patients with advanced NSCLC after ICI implementation in Denmark. In ICI-treated patients, PS ≥ 1, and bone and liver metastases were associated with a worse prognosis.