Real-world Data of First-line Treatment with Pembrolizumab for NSCLC with High PD-L1 Expression in Elderly Patients: a Subgroup Analysis of HOT/NJLCG2001

Overview

Journal Jpn J Clin Oncol

Publisher Oxford University Press

Specialty Oncology

Date 2024 Dec 10

PMID 39656678

Authors

Kazunari Tateishi

Hidenori Mizugaki

Yasuyuki Ikezawa

Ryo Morita

Keiki Yokoo

Toshiyuki Sumi

Mari Aso

Hajime Kikuchi

Atsushi Nakamura

Motoki Sekikawa

Fumiaki Yoshiike

Yasuo Kitamura

Nozomu Kimura

Tsutomu Hachiya

Kyoji Tsurumi

Toshihiko Agatsuma

Furuta Megumi

Keiichi Nakamura

Daisuke Jingu

Hiroshi Yamamoto

Makoto Kosaka

Hiroshi Yokouchi

Affiliations

Soon will be listed here.

Abstract

Background: In the first-line treatment of elderly patients with advanced-stage non-small cell lung cancer (NSCLC) with high programmed death-ligand 1 (PD-L1) expression (tumor proportion score ≥ 50%), this study aimed to determine whether pembrolizumab monotherapy (MONO) or pembrolizumab plus platinum-based chemotherapy (COMB) should be selected.

Methods: We performed a retrospective multicenter study (sub-analysis of the HOT/NJLCG2001 trial) of 299 patients with NSCLC with high PD-L1 expression who received MONO or COMB as the first-line treatment between December 2018 and January 2020. We selected patients aged 75 years and older and assessed the clinical efficacy and toxicity.

Results: In total, 81 (median age: 79 years) and 19 (median age: 76 years) patients received MONO and COMB, respectively. Twenty patients with a performance status (PS) score of 2-3 were enrolled in the MONO group. The median progression-free survival (PFS) was 7.8 and 8.9 months in the MONO and COMB groups, respectively. The median overall survival (OS) was 14.6 and 20.3 months, and the 2-year survival rates were 38.8 and 49.9%, respectively. Furthermore, 29.6% and 26.3% of patients discontinued treatment due to adverse events, respectively. In MONO, patients with PS 0-1 had a longer PFS (10.5 months) and OS (21.7 months) than those with PS 2-3 (0.7 and 1.6 months, respectively).

Conclusion: Some elderly patients with NSCLC and high PD-L1 expression might benefit from COMB; however, MONO is considered the preferred treatment. MONO may not be an effective or feasible treatment for patients with PS 2-3, even with high PD-L1 expression.

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